Hip dysplasia is a common congenital malformation of the hip joint that, if left untreated, can cause significant problems and ultimately lead to secondary coxarthrosis (hip osteoarthritis). This article explains the causes, symptoms, diagnostic procedures and treatment options for hip dysplasia. Learn why early diagnosis and treatment are crucial and how modern medical approaches can improve the quality of life of those affected. He also covers secondary coxarthrosis in detail, its symptoms and treatment options.

What is Hip Dysplasia?

Hip dysplasia refers to maldevelopment of the hip joint in which the hip socket is not deep enough to fully enclose the femoral head. This misalignment leads to an unstable connection between the hip socket and the femoral head, which can lead to uneven stress on the joint and long-term damage. Hip dysplasia is common in newborns and is more common in girls than boys.

Anatomy of the hip joint

The hip joint is a ball-and-socket joint that consists of the femoral head and the acetabulum. The femoral head is the spherical upper part of the femur that fits into the hip socket of the pelvic bone. This construction allows for great freedom of movement and stability of the joint. In hip dysplasia, the hip socket is often too shallow to securely support the femoral head, leading to instability and increased wear and tear on the articular cartilage.

Causes of hip dysplasia

The exact causes of hip dysplasia are not fully understood, but various factors contribute to its occurrence:

Genetic factors

Familial clustering suggests that genetic factors play a role. If a parent or sibling is affected by hip dysplasia, the child's risk of developing it also increases.

Birth position

Breech (breech) babies are at higher risk of hip dysplasia. This position can increase pressure on the fetus's hips and cause malposition.

Gender

Girls are affected more often than boys. This could be due to hormonal differences that affect connective tissue.

Environmental factors

A cramped position in the womb or a lack of amniotic fluid can increase the risk. Swaddling infants with their legs stretched out can also promote the development of hip dysplasia.

Symptoms of hip dysplasia

The symptoms of hip dysplasia can vary and often depend on the patient's age:

In newborns and infants

• Asymmetrical skin folds: Uneven skin folds on the thighs can indicate hip dysplasia.
• Limited mobility: Difficulty spreading the legs or limited mobility in the hip joints.
• Clicking or popping: An audible “click” or “crack” when moving the hips can be a sign of instability.

In older children

• Limping: A noticeable limp can indicate that hip dysplasia is present.
• Leg length difference: Differences in the length of the legs can indicate uneven stress on the hip joint.
• Limited mobility: Difficulty bending or rotating the hips.

In adults

• Pain: Pain in the groin or hip area, especially after physical activity.
• Stiffness: Stiffness and limited mobility of the hip joint.
• Arthritis: Signs of early arthritis in the hip joint.

Diagnosis of hip dysplasia

Hip dysplasia is diagnosed through a combination of clinical examination and imaging techniques:

Clinical examination

The doctor checks the mobility and stability of the hip joint, often using special tests such as the Ortolani and Barlow tests. These tests help to detect instabilities or misalignments of the hip joint.

Ultrasonic

For newborns and infants, ultrasound is the preferred diagnostic tool because it provides a detailed view of the joint. Ultrasound is particularly helpful in assessing the depth of the acetabulum and the position of the femoral head.

roentgen

In older children and adults, an x-ray is often used to assess the exact shape and position of the hip bones. X-rays may also show signs of arthritis or other joint changes.

Treatment options for hip dysplasia

Treatment for hip dysplasia depends on the patient's age and the severity of the malformation:

Conservative treatment

1. Pavlik bandage: A Pavlik bandage is often used in infants to keep the hips in an optimal position and promote normal growth. This brace is a soft, flexible splint that holds the baby's legs in a "frog position," which supports proper hip alignment.
2. Spreaders and splints: These devices keep the hips in a stable position and allow the joint to develop properly. They are particularly useful for older infants and young children.

Surgical treatment

1. Osteotomy: This procedure corrects the alignment of the hip bones to create a better fit between the femoral head and the acetabulum. An osteotomy involves cutting the bone and moving it into a better position to optimize the load on the joint.
2. Total hip replacement (THA): In severe cases or in older patients, replacement of the hip joint with a prosthesis may be necessary. A total hip replacement can relieve pain and improve mobility by replacing the damaged joint with an artificial one.

Prevention and early detection

Early detection is crucial to achieve the best treatment results. Regular checkups for newborns and infants can help detect and treat hip dysplasia early. Parents should pay attention to signs such as asymmetrical skin folds, limited mobility and unusual noises when moving the hips and consult a pediatrician if suspected.

Lifestyle and self-help

Patients with hip dysplasia can improve their quality of life through certain lifestyle changes and self-help measures:

Weight control

Maintaining a healthy body weight can reduce stress on the hip joint and reduce the risk of osteoarthritis. Excess weight increases pressure on the joints, which can lead to faster wear and tear.

physical therapy

Targeted exercises can strengthen muscles, improve joint mobility and relieve pain. Physiotherapy can also help improve posture and movement patterns.

Ergonomic adjustments

Adjusting your workplace and home environment can help reduce stress on your hips. Ergonomic chairs, properly adjusted desks and comfortable beds can make a big difference.

Pain relief

Medications such as painkillers and anti-inflammatory drugs can help relieve acute symptoms. Heat or cold applications can also help relieve pain.

Research and future prospects

Research into hip dysplasia and its treatment options is constantly progressing. New diagnostic methods, improved surgical techniques and innovative therapeutic approaches help to improve the quality of life of those affected. The development of new materials and prostheses as well as the use of robotics and computer assistance in surgery offer promising possibilities for the future.

Genetic research

Genetic studies help to better understand the causes of hip dysplasia and identify potential risk factors. This could lead to preventive measures and targeted treatments in the future.

Regenerative medicine

Regenerative medicine explores ways to repair or regenerate damaged cartilage and other tissues in the hip joint. Stem cell therapies and other innovative approaches could significantly expand treatment options.

Conclusion​

Hip dysplasia is a congenital malformation of the hip joint that, if left untreated, can lead to serious complications. One of the most common consequences is secondary coxarthrosis, a degenerative joint disease caused by uneven wear and tear of the articular cartilage. Understanding the relationships between hip dysplasia and secondary coxarthrosis is therefore of great importance.

The following section provides an overview of secondary coxarthrosis (hip osteoarthritis), its symptoms, diagnostic methods and treatment options.

Causes of secondary coxarthrosis in hip dysplasia

Secondary coxarthrosis develops as a result of uneven loading and wear on the hip joint. In hip dysplasia, the articular surface is unevenly distributed, resulting in increased pressure on certain areas of the articular cartilage. Over the years, this excessive pressure can damage the cartilage, causing inflammation, pain, and ultimately cartilage breakdown. These degenerative changes characterize secondary coxarthrosis.

Mechanisms of the development of secondary coxarthrosis due to hip dysplasia

introduction

Hip dysplasia, a congenital malformation of the hip joint, can lead to secondary coxarthrosis if left untreated. This form of osteoarthritis is a degenerative joint disease characterized by the wear and destruction of the cartilage in the hip joint. The following explains the mechanisms by which hip dysplasia can lead to the development of secondary coxarthrosis.

Anatomical basis of hip dysplasia

In hip dysplasia, the hip socket (acetabulum) is too flat or malformed, so that the femoral head of the thigh bone (femur) is not adequately stabilized. This leads to uneven loading and increased wear on the joint surfaces. Inadequate coverage of the femoral head by the acetabulum can cause the following problems:

1. Instability of the hip joint: The femoral head can easily slip out of the hip socket (subluxation) or be completely dislocated (dislocation).
2. Uneven pressure distribution: Pressure on the femoral head is distributed unevenly, causing excessive stress on certain areas of the joint.

Mechanisms of cartilage wear

The unstable and unevenly loaded hip socket leads to several biomechanical changes that promote the development of secondary coxarthrosis:

1. Increased mechanical stress: The uneven distribution of load on the femoral head leads to increased pressure on specific areas of the articular cartilage. This increased pressure can cause microtears and damage to the cartilage that worsens over time.
2. Abrasion of the articular cartilage: Due to the constant instability and friction between the femoral head and the acetabulum, the protective articular cartilage is worn away, leading to pain and inflammation.
3. Changes in the synovial fluid: Due to mechanical stress and inflammatory processes, the composition of the synovial fluid changes, which affects the lubrication and nutrition of the cartilage.

Inflammatory processes

The mechanical damage to the articular cartilage leads to an inflammatory reaction in the hip joint. These inflammations further contribute to the damage to the cartilage and increase the degenerative process:

1. Release of inflammatory mediators: When articular cartilage is damaged, inflammatory mediators such as cytokines and enzymes are released, which accelerate the breakdown of the cartilage.
2. Synovitis: Inflammation of the lining of the joint (synovial membrane) leads to swelling and increased production of synovial fluid, which causes additional pain and restricted movement.

Bone changes

During the course of hip dysplasia and the resulting coxarthrosis, changes occur in the bones of the hip joint:

1. Osteophyte formation: Due to sustained mechanical stress, bony outgrowths (osteophytes) form at the edges of the joint. These osteophytes can further limit mobility and cause pain.
2. Subchondral sclerosis: The bones beneath the damaged cartilage become denser (subchondral sclerosis) and less shock-absorbing, contributing to further deterioration of the joint.

Clinical symptoms of secondary coxarthrosis

The mechanisms described above lead to the typical symptoms of secondary coxarthrosis:

1. Pain: Initially the pain occurs with exertion, later also at rest. Typically the pain is localized in the groin, thigh or buttocks.
2. Stiffness: The mobility of the hip joint is limited, especially after periods of rest (morning stiffness).
3. Movement restrictions: Patients have difficulty carrying out everyday movements such as bending over, climbing stairs or putting on shoes.

Diagnosis of secondary coxarthrosis in hip dysplasia

The diagnosis is based on a combination of clinical examination, history and imaging tests:

1. Clinical examination: The doctor checks the mobility and stability of the hip joint and looks for signs of pain or restricted movement.
2. X-ray: X-rays show changes in joint space width, osteophytes and subchondral sclerosis, which indicate advanced coxarthrosis.
3. MRI: An MRI can provide detailed images of the soft tissues and cartilage and helps assess the extent of cartilage damage and inflammation.

Treatment of secondary coxarthrosis in hip dysplasia

Treatment is aimed at relieving pain, improving joint function and slowing the progression of the disease:

Conservative measures

1. Physiotherapy: Targeted exercises to strengthen muscles and improve joint mobility.
2. Pain medication: Use of painkillers and anti-inflammatory medications to relieve symptoms.
3. Weight management: Weight reduction to relieve pressure on the hip joint.

Surgical measures

1. Osteotomy: Corrective surgery to improve joint mechanics and reduce stress on the joint.
2. Hip replacement: In advanced cases, a total hip replacement may be necessary to relieve pain and improve mobility.

Conclusion

Hip dysplasia leads to the development of secondary coxarthrosis through a combination of mechanical, inflammatory and bony changes. Early diagnosis and adequate treatment are crucial to maintaining the quality of life of those affected and slowing the progression of the disease.

Symptoms of secondary coxarthrosis

Symptoms of secondary coxarthrosis in hip dysplasia can vary but often include:

• Pain: Initially, pain often occurs after physical exertion, and in advanced stages it also occurs at rest.
• Limited mobility: Patients often report stiffness in the hip joint, especially after sitting or lying down for long periods of time.
• Joint noises: Crunching or cracking noises in the hip joint can indicate cartilage damage.
• Joint deformity: In advanced stages, visible changes and misalignments of the hip joint may occur.

diagnosis

The diagnosis of secondary coxarthrosis in hip dysplasia is made through a combination of clinical examination and imaging techniques:

• Clinical examination: The doctor checks the mobility and pain sensitivity of the hip joint.
• X-rays: These show the shape and depth of the hip socket as well as any changes to the femoral head.
• Magnetic resonance imaging (MRI): This method provides detailed images of the cartilage and soft tissues and helps assess the extent of damage.

Treatment options

Treatment of secondary coxarthrosis in hip dysplasia is aimed at relieving pain, improving the function of the hip joint and slowing the progression of the disease. Depending on the severity of the symptoms and the extent of joint damage, different therapeutic approaches are used:

Conservative treatment

1. Physiotherapy: Exercises to strengthen muscles and improve joint mobility can help reduce stress on the hip joint.
2. Drug therapy: Painkillers and anti-inflammatory drugs (NSAIDs) can relieve acute symptoms.
3. Aids: Orthopedic insoles or walking aids can reduce the strain on the hip joint.

Surgical treatment

1. Arthroscopy: In early stages of coxarthrosis, minimally invasive joint endoscopy (arthroscopy) may be performed to remove damaged tissue and improve joint function.
2. Osteotomy: This surgery realigns the hip bone to optimize load distribution in the joint and reduce wear and tear.
3. Total hip endoprosthesis (THA): In advanced stages of coxarthrosis, it may be necessary to replace the hip joint with an artificial joint.

Prevention and early detection

Early detection and treatment of hip dysplasia is crucial to prevent the development of secondary coxarthrosis. Regular checkups for infants and young children as well as timely treatment of diagnosed hip dysplasia can significantly reduce the risk of complications. Parents should pay attention to signs of hip dysplasia, such as asymmetrical skin folds or limited hip mobility, and consult a pediatrician if suspected.

Conclusion

Secondary coxarthrosis (hip osteoarthritis) in hip dysplasia is a common complication caused by uneven loading and wear on the hip joint. Early diagnosis and treatment of hip dysplasia are crucial to minimize the risk of secondary coxarthrosis. A combination of conservative and surgical treatment approaches can reduce pain and improve hip joint function. Patients should have regular check-ups and seek medical advice at the first signs of hip dysplasia or coxarthrosis to avoid long-term damage.