Hip dysplasia is the most common congenital skeletal development disorder in humans. In Germany, around 2 to 5 percent of babies are born with congenital hip dysplasia every year. The effects of this disorder can have a significant impact on the entire lives of affected children and their parents. Here you will find further information and selected hip dysplasia specialists and centers.
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Brief overview:
- What is hip dysplasia? One of the most common congenital skeletal development disorders in which the acetabulum does not sufficiently enclose the femoral head, which can lead to various complaints.
- Causes: Girls are significantly more frequently affected. Genetic predisposition, complications during pregnancy or a multiple pregnancy or neurological diseases usually cause the condition.
- Treatment: The earlier the condition is recognized and the less severe it is, the more likely it is that conservative measures such as joint repositioning, retention and orthoses will be successful. In rare cases, surgery is necessary.
- Surgery in childhood: An acetabuloplasty between the age of 18 months and 8 years moves a small part of the bone so that the hip socket can better cover and hold the joint.
- Surgery in adulthood: The very complex triple pelvic osteotomy fixes the hip after a bone reduction with screws and achieves very good long-term results, which significantly reduce the symptoms.
- Prevention: The disease cannot be prevented, but early treatment improves the chances of successful treatment. Therefore, the U2 and U3 examinations should definitely be carried out.
Article overview
Background information on hip dysplasia
Hip dysplasia is a malformation of the hip joint socket in which the head of the femur is located. Girls are more frequently affected by this malformation than boys. If hip dysplasia is not recognized, there is a risk of wear and tear(osteoarthritis) in the joint. This can lead to pain and a severe walking disability.
Hip dysplasia can be reliably detected in the first few days of life with the help of a harmless ultrasound examination. Newborns are examined by orthopaedists and pediatricians so that any necessary splint treatment can be started as early as possible.
This ultrasound examination of the hip joint has proved so successful that it has been included in the statutory U3 check-up (4th to 6th week of life after birth).
If hip dysplasia is detected early, there is a very good chance of recovery. With targeted and consistent treatment, healthy hip joints can usually develop. Thus
- any operations that may be necessary later,
- serious hip dysplasia or
- premature hip wear
avoided.
What does hip dysplasia mean?
Hip dysplasia can be congenital or sometimes acquired in the course of life. The acetabulum is often too small and too steep. The head of the hip joint is then not sufficiently covered by the acetabulum, particularly at the sides and front.
The result of this maldevelopment can be a hip dislocation (hip luxation). The femoral head moves laterally upwards/backwards out of the too small acetabulum. Fortunately, however, the proportion of hip dislocations is much lower (only every 15th child with hip dysplasia has a hip dislocation).
Structure of the human pelvis. The ischium runs below the pubic bone © Henrie | AdobeStock
Causes of hip dysplasia
Hip dysplasia is around 5 to 7 times more common in girls than in boys and occurs more frequently in some families. Several siblings are often affected.
Other possible causes of hip dysplasia:
- Mechanical factors such as a multiple pregnancy or
- an insufficient amount of amniotic fluid during pregnancy, which leads to relative constriction for the unborn child.
There are also numerous accompanying neurological diseases, such as
- open spinal canal(spina bifida) or
- as a result of early childhood brain damage(cerebral palsy) or
- also rare genetic diseases
can lead to hip dysplasia.
How is hip dysplasia treated conservatively?
The decisive factors for successful conservative (non-surgical) treatment of hip dysplasia are
- the degree of deformity and
- the early start of treatment.
The more severe the dysplasia or the later it was diagnosed in a person's life, the sooner the doctor will (have to) resort to surgical methods.
Conservative treatment for severe dysplasia and dislocations is based on three main pillars:
- Reduction (setting the joint in the acetabulum),
- retention (ensuring that the femoral head remains in the acetabulum) using a cast or splint/brace, and
- Maturation treatment, i.e. consistent further orthotic treatment under ultrasound monitoring. This allows the joint to develop properly.
In the case of very mild dysplasia and in newborns, it is usually sufficient to wrap the child a little wider and leave it to its natural urge to move.
In most cases, children then have no more problems in their further development and the hips mature well. This maturing of the hip sockets is also monitored by the doctor using ultrasound.
Are there any special preventive measures?
Hip dysplasia cannot be prevented! Even during pregnancy, there are no ways to prevent it.
However, in order to avoid late complications, hip dysplasia should be diagnosed as early as possible, which has been ensured in Germany since 1996 by an ultrasound examination during the U2 and U3 examinations by the pediatrician or orthopedist.
Surgical treatment of hip dysplasia in children
Despite intensive and long-term conservative treatment, residual hip dysplasia may persist.
The chances of success of conservative treatment deteriorate with increasing age. Severe residual hip dysplasia cannot be sufficiently improved by conservative treatment from the end of the 2nd year of life.
Intensive special physiotherapy according to Vojta is still very effective in the first year of life. In the second year of life, however, it already loses its effectiveness.
Hip dysplasia treatment of a newborn using bands and splints © Marko | AdobeStock
Acetabuloplasty is a proven surgical procedure for the treatment of such residual hip dysplasia. The majority of acetabuloplasties are performed between the age of 18 months and 8 years. After the ilium above the acetabulum has been partially severed, a small bone wedge is swung down to the side to better cover the femoral head. The cut-to-size bone wedge is inserted into the resulting gap.
The children undergo follow-up treatment in a plaster cast for a few weeks. Sometimes the hip joints are almost or completely dislocated (luxated). In these cases, after unsuccessful conservative treatment, an open surgical hip joint reduction may be considered.
This treatment is a combination of femoral shortening and acetabuloplasty. It should be carried out in clinics that have many years of experience in this field.
Surgical treatment of hip dysplasia in adulthood
Hip dysplasia is the most common cause of premature, painful hip degeneration. This also makes it the main cause of the need for an artificial hip joint.
Many hip dysplasia patients between the ages of 20 and 40 sometimes have unbearable pain in their hips. They are often unable to work in the long term as a result. Around 200,000 artificial hip joints are now implanted in Germany every year.
Once growth has been completed, there is the option of joint-preserving correction of severe hip dysplasia. The procedure is known as a triple pelvic osteotomy (triple osteotomy). It was developed by Prof. Dr. Tönnis and K. Kalchschmidt at the Dortmund Municipal Clinic in the mid-1970s.
This operation is one of the largest and most complex pelvic operations in orthopaedics. It is therefore only performed more frequently and in a specialized manner in a few clinics in Germany.
Three surgical approaches are required to correct the excessively steep acetabulum using a triple pelvic osteotomy. These are used to
- the ischium,
- the ilium and
- the pubic bone
are severed. These three bones form the acetabulum. Screws are used to fix the bones in the required corrected position.
The operation takes an average of two and a half to three hours.
Fig. 1: Severe hip dysplasia on the right. Orthopaedics EK-Unna; kindly provided by Dr. med. Pothmann.
Fig. 2: Hip dysplasia after triple pelvic osteotomy © Orthopädie EK-Unna; courtesy of Dr. Pothmann.
Patients can leave the hospital after about 12 to 14 days. The prerequisite for this, however, is that they can safely take the weight off the operated leg using two crutches.
This operation can completely eliminate the pain caused by weight-bearing and, in particular, groin pain. Most patients can then return to an active and pain-free lifestyle without any restrictions.
There are long-term results over 20 years after this operation (by Axel Küpper et al., Unna/Dortmund), which is superior to PAO . In POA (periacetabular osteotomy), the acetabulum is chiseled out of the pelvic fusion and then pivoted.
Nevertheless, PAO is performed more frequently worldwide as it is technically less complicated. Unfortunately, the long-term results are worse than with triple osteotomy.