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Hip dysplasia

Hip dysplasia is a congenital disease that, in its more severe form, can eventually cause lameness and painful arthritis of the joints. It is caused by a combination of genetic and environmental factors. It can be found in many animals and occasionally in humans, but is common in many dog breeds, particularly the larger breeds. more...

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Description

In the normal anatomy of the hip joint, the thigh bone (femur) joins the hip in the hip joint, specifically the caput ossis femoris. The almost spherical end of the femur articulates with the hip bone acetabulum, a partly cartilaginous mold into which the caput neatly fits. It is important that the weight of the body is carried on the bony part of the acetabulum, not on the cartilage part, because otherwise the caput can glide out of the acetabulum, which is very painful. Such a condition also may lead to maladaptation of the respective bones and poor articulation of the joint.

In dogs, the problem almost always appears by the time the dog is 18 months old. The defect can be anywhere from mild to severely crippling. It can cause severe osteoarthritis eventually.

Causes

In dogs, there is considerable evidence that genetics plays a large role in the development of this defect. There might be several contributing genetic factors, including a femur that does not fit correctly into the pelvic socket, or poorly developed muscles in the pelvic area. Large and giant breeds are susceptible to hip dysplasia, and cocker spaniels and Shetland sheepdogs are also known to suffer from it. Cats are also known to have this condition, especially Siamese.

Detection

The classic diagnostic technique is with appropriate X-Rays and hip scoring tests. These should be done at an appropriate age, and perhaps repeated at adulthood - if done too young they will not show anything. Since the condition is to a large degree inherited, the hip scores of parents should be professionally checked before buying a pup, and the hip scores of dogs should be checked before relying upon them for breeding.

Prevention

Overfeeding puppies and young dogs, particularly in the giant breeds, might aggravate the problem or bring it on earlier, because pups tend to be more active, less aware of their physical limitations, and have immature bones and supporting structures carrying their weight. Dogs from breeds which are known to be prone to dysplasia, can be kept slightly leaner than normal until around 2 years old, by which time the bones are full strength and the animal can be easily brought up to its normal adult weight. Overexercising young dogs whose bones and muscles have not yet fully developed might also be a contributing factor.

Symptoms

Dogs might exhibit signs of stiffness after rising from rest, reluctance to exercise, bunny-hopping gait, lameness, pain, or wasting away of the muscle mass in the hip area. Radiographs often confirm the presence of hip dysplasia, but radiographic features may not be present until two years of age in some dogs. Moreover, many affected dogs do not show clinical signs, but some dogs manifest the problem before seven months of age, while others do not show it until well into adulthood.

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Congenital hip dysplasia
From Gale Encyclopedia of Medicine, 4/6/01 by Jeffrey Peter Larson

Definition

A condition of abnormal development of the hip, resulting in hip joint instability and potential dislocation of the thigh bone from the socket in the pelvis. This condition has been more recently termed developmental hip dysplasia, as it often develops over the first few weeks, months, or years of life.

Description

Congenital hip dysplasia is a disorder in children that is either present at birth or shortly thereafter. During gestation, the infant's hip should be developing with the head of the thigh bone (femur) sitting perfectly centered in its shallow socket (acetabulum). The acetabulum should cover the head of the femur as if it were a ball sitting inside of a cup. In the event of congenital hip dysplasia, the development of the acetabulum in an infant allows the femoral head to ride upward out of the joint socket, especially when weight bearing begins.

Causes & symptoms

Clinical studies show a familial tendency toward hip dysplasia, with more females affected than males. This disorder is found in many cultures around the world. However, statistics show that the Native American population has a high incidence of hip dislocation. This has been documented to be due to the common practice of swaddling and using cradleboards for restraining the infants. This places the infant's hips into extreme adduction (brought together). The incidence of congenital hip dysplasia is also higher in infants born by caesarian and breech position births. Evidence also shows a greater chance of this hip abnormality in the first born compared to the second or third child. Hormonal changes within the mother during pregnancy, resulting in increased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb. Other symptoms of complete dislocation include a shortening of the leg and limited ability to abduct the leg.

Diagnosis

Because the abnormalities of this hip problem often vary, a thorough physical examination is necessary for an accurate diagnosis of congenital hip dysplasia. The hip disorder can be diagnosed by moving the hip to determine if the head of the femur is moving in and out of the hip joint. One specific method, called the Ortolani test, begins with each of the examiners hands around the infant's knees, with the second and third fingers pointing down the child's thigh. With the legs abducted (moved apart), the examiner may be able to discern a distinct clicking sound with motion. If symptoms are present with a noted increase in abduction, the test is considered positive for hip joint instability. It is important to note this test is only valid a few weeks after birth.

The Barlow method is another test performed with the infant's hip brought together with knees in full bent position. The examiner's middle finger is placed over the outside of the hipbone while the thumb is placed on the inner side of the knee. The hip is abducted to where it can be felt if the hip is sliding out and then back in the joint. In older babies, if there is a lack of range of motion in one hip or even both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position. Also in older infants, hip dislocation is evident if one leg looks shorter than the other.

X-ray films can be helpful in detecting abnormal findings of the hip joint. X rays may also be helpful in finding the proper positioning of the hip joint for treatments of casting. Ultrasound has been noted as a safe and effective tool for the diagnosis of congenital hip dysplasia. Ultrasound has advantages over x rays, as several positions are noted during the ultrasound procedure. This is in contrast to only one position observed during the x ray.

Treatment

The objective of treatment is to replace the head of the femur into the acetabulum and, by applying constant pressure, to enlarge and deepen the socket. In the past, stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position. More recently the Pavlik harness and von Rosen splint are commonly used in infants up to the age of six months. A stiff shell cast may be used, which achieves the same purpose, spreading the legs apart and forcing the head of the femur into the acetabulum. In some cases, in older children between six to 18 months, surgery may be necessary to reposition the joint. Also at this age, the use of closed manipulation may be applied successfully, by moving the leg around manually to replace joint. Operations are not only performed to reduce the dislocation of the hip, but also to repair a defect in the acetabulum. A cast is applied after the operation to hold the head of the femur in the correct position. The use of a home traction program is now more common. However, after the age of eight years, surgical procedures are primarily done for pain reduction measures only. Total hip surgeries may be inevitable later in adulthood.

Alternative treatment

Nonsurgical treatments include exercise programs, orthosis (a force system, often involving braces), and medications. A physical therapist may develop a program that includes strengthening, range-of-motion exercises, pain control, and functional activities. Chiropractic medicine may be helpful, especially the procedures of closed manipulations, to reduce the dislocated hip joint.

Prognosis

Unless corrected soon after birth, abnormal stresses cause malformation of the developing femur, with a characteristic limp or waddling gait. If cases of congenital hip dysplasia go untreated, the child will have difficulty walking , which could result in life-long pain. In addition, if this condition goes untreated, the abnormal hip positioning will force the acetabulum to locate to another position to accommodate the displaced femur.

Prevention

Prevention includes proper prenatal care to determine the position of the baby in the womb. This may be helpful in preparing for possible breech births associated with hip problems. Avoiding excessive and prolonged infant hip adduction may help prevent strain on the hip joints. Early diagnosis remains an important part of prevention of congenital hip dysplasia.

Key Terms

Acetabulum
The large cup-shaped cavity at the junction of pelvis and femur or thigh bone.
Orthosis
A force system designed to control or correct or compensate for a bone deformity, deforming forces, or forces absent from the body.

Further Reading

For Your Information

    Books

  • Chandrasoma, Parakrama and Clive R. Taylor Concise Pathology. East Norwalk, Connecticut: Appleton and Lange, 1991.

    Periodicals

  • Feeney, Tracy. "Early Intervention: Key to Success in Treatment of Infants with Hip Dysplasia." Advance For Physical Therapy (November 1995).
  • Jamali, Mohammed and Kymberly McCoy. "Developmental Dysplasia of the Hip." Advance For Physical Therapy 8 (18) (May 1998).

    Organizations

  • March of Dimes Birth Defects Foundation, National Office. 1275 Mamaroneck Avenue, White Plains, NY 10605.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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