How to treat hip dysplasia in children

Physical health is not only a concern for adults, but children need to pay more attention to it. If the joints are injured in childhood, they should be treated immediately and measures should be taken to recover to prevent the joints from getting worse and worse, leading to serious consequences. Generally speaking, if the hip joint is poorly developed, it will cause walking difficulties and may even lead to hemiplegia, unstable gait and other problems. So how do we view hip dysplasia in children?

Developmental dysplasia of the hip (DDH), also known as developmental dislocation of the hip, is the most common hip disease in pediatric orthopedics, with an incidence rate of about 1‰. The incidence rate in girls is about 6 times that in boys, the left side is about twice that of the right side, and bilateral incidence accounts for about 35%. DDH includes hip dislocation, subluxation and acetabular dysplasia, which is more representative of all the deformities of the disease than the previous name "congenital hip dislocation".

Cause: Caused by multiple factors. Risk factors for this disease include: girls, first child, multiple births; family history; malposition of the fetus, such as breech presentation, low amniotic fluid; plantar fasciitis or muscular torticollis; incorrect swaddling method - candle wrapping.

Treatment: 1. Newborns and children under 6 months old: Diagnosis is best made in the neonatal period and treatment is given immediately upon discovery. The most commonly used treatment is the Pavlik harness, which has a 95% recovery rate for hips with a positive Ortolani sign. The Pavlik onesie harness is suitable for infants with DDH under 6 months old. The failure rate of the Pavlik onesie harness is greater than 50% for infants over 6 months old. During the first 3 weeks of treatment, the Pavlik harness should be worn and checked weekly, and ultrasound examinations should be performed. If the hip joint is reduced and stable, the follow-up time should be extended until the ultrasound examination is normal. If the Pavlik harness is not reduced after 3 weeks of treatment, the treatment has failed and other treatments should be used. Complications of Pavlik harness treatment include: downward dislocation of the hip, femoral nerve and brachial plexus paralysis, and avascular necrosis of the femoral head.

Children aged 2.6 to 18 months: For children in this age group, subluxation or dislocation of the hip should be treated with closed reduction or open reduction as the first choice of treatment. For those with acetabular dysplasia, bracing can be used. Closed reduction must be performed under basic anesthesia. If intraoperative arthrography shows that the reduction is satisfactory and stable, human position plaster fixation will be given. The hip joint is required to be flexed between 100 and 110°, and the abduction cannot exceed 60°. Excessive abduction of plaster and brace fixation can easily cause ischemic necrosis of the femoral head. If the closed reduction is unsatisfactory or unstable, open reduction of the hip joint is required. Generally, simple open reduction of the hip joint plus human position plaster fixation is performed. After plaster fixation, fluoroscopy is performed in the operating room to understand the reduction of the hip joint. Before discharge, the hip joint should be reviewed in AP radiograph and, if necessary, CT or MRI examination should be performed to understand the reduction status. Ultrasound examination can be used for some follow-up examinations after discharge to reduce the number of X-ray examinations. Usually the plaster is fixed for about 3 months and then replaced with a brace for about 3 months. The potential for acetabulum development after closed or open reduction is great and can continue for 4 to 8 years after reduction. Most children with DDH do not need a second acetabular or femoral surgery.

3. Children aged 18 months to 8 years: Children with DDH older than 18 months have poor potential for acetabular development. Most of them need to undergo pelvic osteotomy at the same time as hip open reduction. Children with DDH under 4 years old can choose Salter, Pemberton, Dega and other pelvic osteotomies. Children with high dislocation, high joint pressure after reduction, large anteversion angle and neck-shaft angle need to undergo proximal femoral shortening, derotation and varus osteotomy at the same time. For children older than 4 years old, triple pelvic osteotomy can be performed at the same time as the above surgery for complex situations such as re-dislocation after surgery. The doctor needs to decide the specific surgical method based on factors such as pathological changes in the hip joint and the age of the child.