DEVELOPMENTAL HIP DYSPLASIA ? (DDH)(Keywords: Developmental Hip Dysplasia, hip arthritis, femero acetabular impingement syndrome, chiropractic) At the Chiropractic Coalface one comes regularly into contact with patients who have had less-than-satisfactory hip replacement surgery. In addition, I personally have several patients every single day who are experiencing hip (not sacro-iliac joint) and groin pain. Hence the beginning of a long journey of self-discovery about the hip joint. Prevention of hip arthritis is vital and DDH was not, in my day, something we learned about in Chiropractic School. Nor was Femero Acetabular Impingement Syndrome, DDH's first cousin. Both if poorly managed have a high predeliction for hip arthritis.
"If left untreated, and the condition does not resolve on its own, the long-term consequences are very serious, including a shorter leg and a pronounces limp, with premature onset of arthritis and hip pain." Orthopaedic Topics
THE NORMAL HIP JOINT
Both the ball and the cup are lined with super-slippery, hard hyaline cartilage so that one doesn't have bone-on-bone contact. The hip joints after all bear the full weight of the body. The joint is filled with a nutrient-rich fluid that sloshes about supplying the cartilage with oxygen and all it's needs for metabolism - it's living tissue, just as muscle, bone and nerves are. Cartilage has no blood supply of its own (as muscle, bone... do). This hyaline fluid also removes the waste products of cartilage metabolism.
HYALINE CARTILAGE ... IN UTERONotice the position of the thighs in this normal vertex presentation... the "taylor's position" with flexed and ABducted hips. The ball is kept firmly in the socket.
Thus it's vital the pregnant woman does not in the last trimester spend long hours sitting in a cramped position. Stretching out whilst lying, walking, swimming ... is essential, simply to make space for the developing infant. Whilst DDH almost certainly has an underlying genetic predisposition, scientists reason that the position of your babe in utero is profoundly important. Read further...
DEVELOPMENTAL HIP DYSPLASIA ... what happens in utero?
In the X-ray below of DDH, there is a shallow socket, with a sloping upper margin instead of a proper roof. In addition the lower margin of the acetabulum is barely seen.
ANCILLARY FINDINGS ...Notice, in comparison with the normal hip above, how a much larger portion of the ball protrudes beyond the socket; it is un-roofed, and cannot contribute to bearing the weight of the body. The nett result is that the weight of the body is concentrated on a much smaller area of cartilage between the ball and socket, with far greater stress on the hyaline cartilage and underlying bone. Notice too, instead of a nice round ball, the flattened, 'mushroom-shaped' medial margin of the ball; this is a finding common to several hip abnormalities.
This patient already has pain in the groin radiating down the inner thigh muscles, pain on the side of the hip, and sacro-iliac joint pain. She also has short leg causing a tilted pelvis and a curvature of the spine. Undiagnosed Development Hip Dysplasia causes a leg length inequality. Take no positive action and there's a hip replacement waiting in the wings. It won't be long before hiking will become painfully impossible.
LEG LENGTH INEQUALITY ... EXAMINATION OF THE INFANTIf you take your colicky baby to a Chiropractor s/he will during the routine examination gently flex the hips, moving this way and that, listening for a deep-sounding 'thunk' as the hip subluxates. In fact whilst caring for your child, you too should listen out for odd sounds coming from the hip joints.Whilst only 1 / 1 000 babies (about 80% girls) have Developmental Hip Dysplasia, it's probably a much higher percentage of unhappy, colicky babies. In the clicking hip of the small infant, the diagnosis of DDH is confirmed with a ultrasound scanner which allows the radiologist to view the hip whilst it's in motion. S/he'll actually will see the hip subluxate as it clicks. In serious cases the hip actually dislocates. That's a disaster. In mild cases it simply subluxates and clicks and becomes arthritic in later life. Your chiropractor, if s/he is experienced in the examination of the infant will be doing these tests, Hip Dysplasia Ortolani Galeazzi Barlow, noted orthopaedists to whom the world is indebted for their enormous contribution to the understanding of Developmental Hip Dysplasia.
The CAUSE?There is a strong genetic predeliction for Developmental Hip Dysplasia. If Granny or Gramps had an arthritic hip, then every one of their children and grandchildren should be routinely examined for abnormalities like Developmental Hip Dysplasia (DDH) and Femero Acetabular Impingement Syndrome (FAIS).Breech births increase the likelihood of DDH too, by a very large margin of ten. Now it's 1/ 100 babies. Add to that the effect of a constrained, tight intrauterine last-trimester, and a poor diet, and smoking, and we may be looking at 1/20 - 1/50 births.
TREATMENTThe treatment of the infant with DDH cannot be successfully achieved only with chiropractic. Your chiropractor would reduce the subluxation, but modern care involves an orthopaedic device called the Pavlik harness which keeps the head of the femur firmly in the socket.Why? Because in the newborn, the socket hasn't yet properly formed. It's the presence of the ball in the socket that builds a proper socket and to date that can only be done by successfully keeping the femoral head firmly in the acetabulum - that's what moulds the socket to the correct shape. However, in the child, young adult and adult, I believe that chiropractic has a major role to play. Currently I have one adult woman of 45, two young women in their early twenties and one girl of nine under care. All four have far less pain, and are more than satisfied with chiropractic care. All four had been less than satisfactorily managed medically. Developmental Hip dysplasia CaseFile ...
It's widely acknowledged medically that Developmental Hip Dysplasia leads unerringly to hip arthritis and surgery. "Total hip surgeries may be inevitable later in adulthood." |
