Hip dysplasia can be caused by various factors, including genetic predisposition, breech position in the womb, and other environmental factors. It is more common in females and firstborn children. If left untreated, it can lead to walking problems, hip pain, and osteoarthritis (joint degeneration) in later life. Hip dislocation is one of the leading causes of preventable or correctable limping.

Early diagnosis and treatment are crucial for better outcomes. Treatment options may include the use of a special device or brace to keep the hip joint in place or, in severe cases, surgery to correct the position of the hip joint.

What Are the Symptoms of Hip Dislocation?

Developmental hip dysplasia (DHD), also known as hip dislocation, can manifest with various symptoms depending on the severity of the condition. Some common signs and symptoms associated with DHD include:

Loss of movement in the hip joint: This can often be noticed when changing diapers in babies, where one leg may be harder to open than the other. In cases of bilateral dislocation, it may be difficult for caregivers to detect.

Asymmetrical thigh or gluteal (buttock) folds where one side appears higher or fuller than the other: Differences in the folds at the back of the legs can be a sign of hip dislocation, although this alone may not confirm the diagnosis as asymmetry can sometimes be normal.

Clicking or popping sensation in the hip joint during movement: This is often associated with the ability of the examining doctor to easily dislocate and reposition the hip joint. In some cases, caregivers may also notice this.

Unequal leg lengths, where one leg appears shorter than the other: In unilateral dislocations, differences in leg length can be detected by caregivers, especially before the child reaches one year of age, due to the higher placement of the dislocated hip.

In severe cases, complete dislocation of the hip joint can cause the affected leg to appear shorter and more outwardly rotated compared to the unaffected side: This is more pronounced in children with a significant limp when they start walking.

It is important to note that some babies with hip dislocation, especially milder cases, may not show any noticeable symptoms. Therefore, regular physical examinations by an orthopedic doctor are crucial for early detection and appropriate treatment of developmental hip dysplasia. Additionally, imaging studies such as ultrasound or X-rays may be requested to confirm the diagnosis and assess the severity of the condition.

Ultrasound in Hip Dislocation Diagnosis

Ultrasound is a commonly used imaging method for diagnosing developmental hip dysplasia (DHD) in infants.

Ultrasound is typically performed when there are clinical signs or risk factors for DHD, such as breech presentation at birth, a family history of hip dysplasia, or abnormal physical examination findings (e.g., limited hip abduction, asymmetrical thigh or gluteal folds). In countries like Turkey, where hip dislocation is common, it is also included in routine screening programs.

Evaluation of the Hip Joint: An ultrasound probe is placed over the hip joint to obtain images that assess the structure and stability of the joint.

Ultrasound provides measurements of various parameters, such as the alpha angle and acetabular depth-to-width ratio, which are used to evaluate the severity of hip dysplasia. The alpha angle measures the relationship between the femoral head (the ball of the hip joint) and the acetabulum (the socket of the hip joint). In normal hips, the alpha angle is typically greater than 60 degrees, indicating a well-formed and aligned hip joint. A decreased alpha angle (<60 degrees) suggests hip dysplasia or dislocation.

The diagnosis of congenital hip dislocation (developmental hip dysplasia) can be easily and painlessly made through ultrasound screening. Hip ultrasound screening in infants is usually performed between the first and second months after birth. Since ultrasound uses sound waves, it poses no harm to the child. After six months, as the hip bones begin to mature, ultrasound may not provide enough information, and X-rays taken in the frog-leg position are used for diagnosis in children older than six months.

Hip Dislocation and Swaddling

While swaddling has its benefits, it’s essential to ensure that the baby’s hips have enough room for healthy development. Excessively tight swaddling or incorrect positioning can increase the risk of developmental hip dysplasia (DHD). A safe swaddling technique involves allowing the baby’s legs to bend and move freely at the hips. While there is no known harm in swaddling the arms tightly, the hip area should be swaddled loosely.

Hip Dislocation and Pavlik Harness

The Pavlik harness is a commonly used device for treating developmental hip dysplasia (DHD) in infants. It is the most important treatment option for early-detected cases where the hip can be repositioned without the need for surgery.

The Pavlik harness is designed to hold the hip joint in a position that supports proper development while allowing natural movement and growth. It is used in infants with mild to moderate DHD, where the hip joint can still be reduced (returned to the socket) without requiring surgery.

The Pavlik harness consists of soft fabric straps and adjustable buckles that secure around the baby’s chest, shoulders, and legs. The harness includes padded shoulder straps, a waist belt, and foot stirrups that help position the hips correctly. The harness can be adjusted to accommodate the baby’s growth and is custom-fitted to ensure comfort. Therefore, the use of the Pavlik harness poses no risk related to the child’s growth.

The Pavlik harness is applied after the orthopedic physician reduces the hips into the socket, and the straps are secured in the correct position. It is recommended to mark the straps with a pen to ensure they stay in place after positioning.

During harness application, the baby is positioned on their back (lying on their back). The straps are adjusted to keep the hips in the correct position, with the knees bent and the hips opened outward. The straps are secured tightly but not too tight, allowing for proper circulation and movement.

The duration of Pavlik harness treatment depends on the severity of DHD and the response to treatment.

Infants wear the harness full-time (23 hours a day), with short breaks for bathing and skincare. Frequent removal of the harness and breaks in treatment are not recommended.

Follow-up is recommended at least every three weeks during treatment to assess hip development and ensure proper application. Depending on the child’s age, follow-up may include ultrasound or X-ray monitoring.

Special attention should be given to maintaining skin hygiene, monitoring for signs of skin irritation or redness, and ensuring the harness straps remain securely fastened.

Once the hip joint stabilizes and imaging studies show satisfactory hip development, the Pavlik harness treatment can be discontinued. The orthopedic physician will determine when it is appropriate to stop using the harness based on clinical and radiographic evaluations.

After Pavlik harness treatment, ongoing monitoring may be necessary to ensure stable hip development and to evaluate for any residual hip dysplasia or related issues. Even if the hip joint has been successfully repositioned and adequate development has occurred with the harness, follow-up should continue periodically until the child is 15 years old.

Overall, the Pavlik harness is an effective, non-invasive treatment option for infants with DHD. It promotes proper hip development and reduces the need for surgery in many cases. However, successful outcomes depend on early diagnosis, proper harness application, careful monitoring, and adherence to treatment protocols. Parents and caregivers play a crucial role in supporting their baby’s treatment journey by following the orthopedic physician’s recommendations and participating in ongoing care and follow-up.

Surgical Treatment Methods for Hip Dislocation

Surgical intervention for developmental hip dysplasia (DHD) is typically considered when conservative treatments like harnesses or casting do not provide sufficient hip joint stability or fail to reduce hip dysplasia. Surgical interventions aim to reposition and stabilize the hip joint, support proper development of the hip socket (acetabulum), and address any problems associated with DHD. These procedures range from soft tissue adjustments to correcting bone structures and reshaping the hip socket.

Open Reduction With or Without Pelvic Osteotomy:

Open reduction is often considered for infants with severe hip dysplasia or dislocation that cannot be adequately treated with non-surgical methods. During open reduction, the surgeon makes an incision to directly access the hip joint. The femoral head is repositioned within the acetabulum, and any soft tissue barriers preventing reduction are removed. In some cases, additional procedures such as pelvic osteotomy (reshaping the bones of the pelvis) may be performed to improve femoral head coverage by reshaping the acetabulum.

Closed Reduction With or Without Arthrography:

Closed reduction is a less invasive alternative to open reduction for infants with less severe hip dysplasia. It may also be considered as a salvage procedure if open reduction fails. Closed reduction involves manipulating the hip joint without making an incision to reposition the femoral head within the acetabulum. Fluoroscopy or ultrasound guidance (arthrography) may be used to assist in achieving proper reduction. After successful closed reduction, a cast may be applied to immobilize the hip and allow for healing. The duration of cast immobilization depends on factors such as age, severity of dysplasia, and stability of the reduction.

Following surgical intervention, close monitoring of the hip joint is essential to evaluate proper healing, joint stability, and range of motion. Physical therapy may be initiated to support muscle strength, joint mobility, and motor development. In some cases, additional follow-up surgeries may be needed to maintain optimal hip function and address any residual issues related to DHD. Follow-up imaging studies are performed regularly to assess hip joint development and detect any potential complications.

Possible Problems in Hip Dislocation Follow-Up

Potential issues associated with the surgical treatment of developmental hip dysplasia (DHD) include infection, avascular necrosis of the femoral head, redislocation, and leg length discrepancies. Careful preoperative planning, meticulous surgical technique, and proper postoperative management are essential to minimize the risk of these problems and optimize outcomes.

The success of surgical treatment for DHD depends on various factors, such as the severity of the dysplasia, the child’s age at the time of intervention, the surgical technique used, and postoperative management. Early diagnosis and intervention, combined with comprehensive multidisciplinary care, can lead to positive outcomes, including improved hip joint stability, function, and long-term joint health.

Family Education in Hip Dislocation:

Family education is a critical component of the surgical treatment of DHD. Since the patients in this group are children and most cannot manage their own care, family education is essential. Parents should be informed about the nature of the condition, treatment options, the potential risks and benefits of surgery, and what to expect during postoperative recovery and rehabilitation.

Clear communication with the healthcare team and active participation in decision-making can help achieve the best outcomes and patient satisfaction.

It’s important to note that the specific surgical approach and techniques used may vary depending on individual patient factors, the preferences of the physician, and the experience of the surgeon. Therefore, the decision to pursue surgical intervention for DHD should be made in consultation with a multidisciplinary team of healthcare professionals, including orthopedic surgeons, radiologists, physical therapists, and pediatric specialists, to tailor the treatment.

Frequently Asked Questions

What are the signs and symptoms of developmental hip dysplasia (DHD)?
Symptoms of DHD include limited range of motion in the hip joint, asymmetrical thigh or gluteal folds, a clicking or popping sensation in the hip, unequal leg lengths, and a preference for one leg over the other when crawling or walking.

How is developmental hip dysplasia diagnosed?
DHD is typically diagnosed through a combination of physical examination, including the Ortolani and Barlow tests, and imaging studies such as ultrasound or X-ray to assess hip joint morphology and stability.

When should a child be screened for developmental hip dysplasia?
Screening for DHD is usually performed between the first and second months after birth as part of routine newborn checkups.

What are the treatment options for developmental hip dysplasia?
Treatment depends on the severity of the condition and the child’s age. Options include observation, the use of a Pavlik harness to hold the hip in place, or surgical interventions such as closed or open reduction, with or without osteotomy.

How does the Pavlik harness work, and how long is it worn each day?
The Pavlik harness is a device used to keep the hip joint in a stable position, allowing for proper alignment and development. It is usually worn full-time, 24 hours a day, for several weeks to months, depending on the severity of hip dysplasia and the child’s response to treatment.

What are the potential complications of untreated developmental hip dysplasia?
If left untreated, DHD can lead to walking difficulties, hip pain, and osteoarthritis in later life. Severe cases can cause permanent deformity and functional impairment of the hip joint. Unilateral shortening can eventually result in spinal curvature and scoliosis.

What is the prognosis for children with developmental hip dysplasia?
With early diagnosis and appropriate treatment, the prognosis for children with DHD is generally favorable. However, outcomes can vary depending on the severity of the condition and the effectiveness of the treatment.

Can developmental hip dysplasia be prevented?
While some risk factors for DHD, such as breech presentation, cannot be prevented, early screening and intervention can help reduce the severity of the condition and minimize long-term complications. Early use of harnesses or simpler surgical procedures can lead to good long-term results.

Gout is actually a very old medical condition, dating back thousands of years. People noticed the symptoms and effects of gout thousands of years ago. Historical records contain information describing the symptoms and signs of gout during the time of the Egyptians, Ancient Greeks, and the Roman Empire.
Hippocrates called gout “podagra” and stated that the disease was associated with painful swelling in the joints. During the Middle Ages, gout was often associated with wealth and was known as the “disease of the rich” because those affected were often described as consuming high protein and rich foods.
With the advancement of medicine, greater understanding has been gained regarding the origin and treatment of gout. Gout is a metabolic condition caused by increased levels of uric acid in the body and has been linked to various factors such as nutrition, genetic factors and lifestyle.
Modern medicine has developed advanced treatments and medications to better understand and treat gout. The history of gout has progressed in parallel with the evolution of medical science and advances in the diagnosis and treatment of this disease.

What are the symptoms of gout disease?

The first symptoms of gout are usually sudden onset of severe pain and swelling. Usually the disease begins in the joint around the big toe. These pain attacks usually begin at night or early in the morning and are characterized by severe pain, swelling, redness and tenderness. Gout attacks occur suddenly and sometimes reach their peak within a few hours. The pain is often severe and the patient can make the joint very painful with even light contact. In addition to these symptoms, fever, fatigue, and a general feeling of discomfort may also occur during gout attacks. These symptoms often become more frequent and severe as the disease progresses. However, the symptoms of gout may vary from person to person, and following any attack, the symptoms may disappear for a certain period of time. In the long term, gout can cause joint damage, the buildup of petrified uric acid crystals, and the formation of kidney stones.

How is Gout Diagnosed?

Diagnosis of gout is usually made by a doctor through evaluation of signs and symptoms. Diagnosis may often include these steps:

Evaluation of Symptoms: The doctor begins by listening to the patient’s symptoms. Details such as severe joint pain, swelling, redness, and how often and for how long these symptoms have been present are taken into consideration.

Physical Examination: The doctor examines the affected joints and checks for physical findings such as swelling, redness, or tenderness.

Blood Tests: Blood tests are often helpful in diagnosing gout. It is specifically used to measure blood uric acid levels. High uric acid levels can be an indicator for gout, but sometimes high uric acid levels do not always mean gout.

Joint Fluid Analysis: In doubtful cases, the fluid in an affected joint can be sampled and examined. If uric acid crystals are present in this analysis, the presence of gout can be confirmed.

Imaging Tests: Imaging tests, such as radiographs or ultrasound, may be used to evaluate joint damage or crystal buildup from gout.

The physician diagnoses gout using a combination of symptoms, test results, and physical examination. These steps in the diagnostic process help diagnose the disease and create an appropriate treatment plan. The diagnostic process may differ for each patient, so it is important to consult a qualified healthcare professional.

How to Treat Gout?

Painkillers and Anti-Inflammatory Drugs: They can be used to relieve pain and inflammation during gout attacks. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids are often prescribed for this purpose.

Uric Acid Medications: These medications help reduce uric acid levels in the body. Medications such as allopurinol and febuxostat can reduce the frequency and severity of gout attacks by reducing uric acid levels.

Anti-Inflammation Medications: Medications such as colchicine can be used to reduce inflammation at the beginning of gout attacks and in severe cases.

Prophylactic Treatment Medications: There are also medications used to prevent gout attacks in people with chronic gout disease. For example, medications that lower uric acid levels, such as allopurinol, may be prescribed for long-term use.

Effective Diet and Lifestyle Changes: Diet and lifestyle changes are also recommended along with medications in the treatment of gout. This may include factors such as avoiding foods high in purine, avoiding alcohol, drinking enough water, and maintaining an ideal weight.

The spine is a structure consisting of bones that are the support system of our body. The canal formed by these bones is called “spinal canal” or “spinal canal”.

Spinal stenosis is a condition where the nerves in the spinal cord are compressed as a result of the narrowing of this canal. This narrowing may sometimes be congenital or may develop with age. Depending on the severity and location of the narrowing, it may cause pain, tingling, numbness and even limitation of movement in the waist, back, neck, arms and legs.

Spinal stenosis in young people is more often associated with congenital structural problems. However, this situation occurs in the elderly; It may develop as a result of long periods of inactivity, excess weight, chronic diseases, spinal deformities, a herniated disc or progression of conditions such as arthritis. Other risk factors include smoking, genetic predisposition and chronic trauma.

Spinal stenosis is more common in men than in women. The risk increases especially in individuals over the age of 50. However, it is possible to encounter this condition in young people due to some genetic disorders or trauma.

When diagnosed early, relief and symptoms can be controlled with treatment options. Therefore, it is recommended to consult a specialist immediately when signs and symptoms are noticed.

What are the symptoms of canal stenosis?

Spinal stenosis does not present the same symptoms in every individual. Some people experience obvious symptoms, while others may experience no symptoms at all. Even if stenosis is detected in the canal in radiological tests, especially MRI (MRI) and Computed Tomography (CT) examinations, the individual may not feel any discomfort. However, it should not be forgotten that spinal stenosis is generally a slowly progressive condition and symptoms may increase or worsen over time. For this reason, early diagnosis and follow-up are very important.

What are the Risk Factors of Spinal Stenosis?

Some risk factors that may cause the development of spinal stenosis are listed below:

1. Bone Overgrowths : Overgrowths in bones resulting from joint calcification can narrow the spinal canal. These outgrowths usually form in response to calcification.
2. Disc Herniation : As we age, the intervertebral discs located between the vertebrae can lose water, causing the discs to protrude or herniate. This can cause narrowing of the spinal canal.
3. Thickening Ligaments : Thickening of the ligaments that hold the vertebrae together over time can lead to narrowing of the spinal canal.
4. Spinal Injuries : Injuries to the spine as a result of traffic accidents or other traumatic events may cause narrowing of the spinal canal.
5. Spinal Tumors : Benign or malignant tumors occurring in the spinal cord or around the spinal canal can cause narrowing of the canal.
6. Congenital Spinal Stenosis : Some people are born with a narrower spinal canal. The risk of spinal stenosis may increase in these people as they get older.

How Is Spinal Stenosis Diagnosed?

The following steps are taken to diagnose spinal stenosis:

1. Physical Examination : Your doctor will perform a physical examination after listening to your signs and symptoms. During the examination, the location and severity of your pain and whether it changes with movement are evaluated.
2. Neurological Evaluation : Neurological symptoms such as balance, walking style, reflexes and muscle strength are evaluated.
3. Imaging Tests : Depending on your doctor’s recommendation, one or more imaging tests may be ordered. These may be x-rays, MRI (Magnetic Resonance Imaging), CT (Computed Tomography) or myelography. These tests are used to detect the presence of any narrowing or other abnormalities in the spinal canal.

What are the Treatment Methods for Spinal Canal Narrowing?

Treatment of spinal canal stenosis may vary depending on the severity of the patient’s complaints, the location and cause of the stenosis. The treatment approach generally consists of the following stages:

1. Exercises Applied at Home : In patients with mild complaints, some special exercises are recommended to relieve spinal canal narrowing. The purpose of these exercises is to relieve pressure on the spinal canal.
2. Physical Therapy : Physical therapy is used to improve the patient’s spinal functions, reduce pain and increase mobility. An expert physiotherapist determines the exercises and practices appropriate to the patient’s needs.
3. Medication : Anti-inflammatory medications, painkillers, and sometimes muscle relaxants can help reduce pain and inflammation.
4. Interventional Pain Treatments : If complaints do not decrease, interventional treatment methods such as epidural steroid injections can be tried. This method is applied to reduce inflammation and relieve pressure on the spinal cord.
5. Surgical Treatment : If there is no response to conservative treatment methods or if the patient’s condition worsens rapidly, surgical intervention may be decided. Surgery is performed to widen the narrowed spinal canal.
6. Emergency Surgical Situations : If the patient develops neurological symptoms such as sudden loss of strength in the legs or problems with bladder or bowel control, this is considered an emergency and immediate surgical intervention may be required.

Since the treatment approach may be different for each patient, doctor’s advice is essential to determine the most appropriate treatment option.

Osgood-Schlatter disease (OSH) is a condition characterized by pain and swelling in the front of the knee, which usually occurs during growth spurts in adolescence. This condition, which mostly affects young athletes, is characterized by a painful bulge at the bottom of the knee, especially on the tibia (shin bone).

The main cause of Osgood-Schlatter disease is the constant and repeated stretching of the patellar tendon against the apex of the bone called the tibial tuberosity. This stretching occurs especially with frequent running, jumping and bending the knees. This constant stretching can cause minor micro-injuries in young people when the bone is still immature. The body begins the healing process in response to these injuries, causing swelling, pain, and bone growth in the area.

What are the symptoms of Osgood-Schlatter Disease?

The most common symptoms of Osgood-Schlatter disease are:

• Pain in the front and lower part of the knee.
• Pain that increases with physical activity.
• Pain that gets worse after activity.
• Swelling and tenderness in the tibial tuberosity.
• Sometimes redness on the knee.

How is Osgood-Schlatter Disease Diagnosed?

Diagnosis is usually made by the patient’s clinical history and physical examination findings. However, sometimes imaging tests such as x-rays may be performed to rule out other conditions or to evaluate the severity of OSH.

How is Osgood-Schlatter Disease Treated?

Osgood-Schlatter usually responds well to treatment, and most teenagers fully recover from the condition by adulthood. The main goal of treatment is to reduce pain and control inflammation. Treatment methods may include:

1. Rest and Activity Modification : It is necessary to rest the affected knee to reduce pain. This may mean taking a break from sports or physical activities for a while.
2. Cold Application : Applying a cold compress to the painful area can help reduce swelling.
3. Painkillers : Painkillers and anti-inflammatory medications such as ibuprofen can reduce pain and swelling.
4. Physical Therapy : Physical therapy can help reduce pain by providing techniques to strengthen muscles and increase flexibility.
5. Use of Knee Pads : Special knee pads can be used to support the knee.

What are the complications and long-term effects of Osgood-Schlatter Disease ?

Long-term complications of OSH are rare. However, in some young people, a permanent protrusion may remain on the tibial tuberosity. This is mostly a cosmetic concern and does not pose a functional problem. Osgood-Schlatter disease is a temporary but sometimes bothersome condition that often affects young athletes. With early diagnosis and appropriate treatment, most young people can be protected from the negative effects of this condition and can return to normal physical activities. It is important for parents and coaches to recognize this condition in youth and take immediate action for appropriate treatment.

Poor posture can be caused by many reasons, such as those who work in front of the computer for a long time, those who carry heavy loads and genetic factors. A healthy posture is essential for spine health and overall comfort. Correct posture respects the natural curves of the spine and maintains muscle balance. Some exercises you can do to correct poor posture are:

1. Chest Opening Exercise:

• While standing or sitting, pull your shoulders back and squeeze your shoulder blades together.
• Hold this position for 5-10 seconds and then relax.
• Repeat this exercise 10-15 times a day.

2. Wall Pasting:

• With your back facing the wall, your heels, hips, shoulders and the back of your head should touch the wall.
• Hold this position for 20-30 seconds.
• Repeat this exercise several times a day.

3. Neck Stretching Exercise:

• Slowly tilt your head to one side, allowing your ear to point toward your shoulder.
• Hold for 20-30 seconds and switch to the other side.
• Repeat on each side 3-4 times a day.

4. Scapula Tightening:

• While keeping your hands on the sides of your hips, bring your shoulder blades together and squeeze them.
• Hold this position for 10 seconds and then relax.
• Repeat 10-15 times a day.

5. Bridge Exercise:

• Lie on your back and bend your knees.
• Lift your hips up and keep your waist straight as you plant your feet on the floor.
• Stay in this position for 20 seconds and then lower slowly.
• Repeat this exercise 10 times a day.

6. Plank Exercise:

• Start in a push-up position but land on your elbows.
• Make sure your body is in a straight line.
• Stay in this position for 20-30 seconds and then rest.

7. Abs Exercises:

• Basic abdominal exercises can help strengthen the muscles that support your posture.
• For example; You can try exercises such as crunches, leg lifts and cycling.

8. Breast Lift:

• On a door frame, place your hands on either side of the frame and push your chest forward.
• Repeat this movement several times a day, holding it for 20-30 seconds.

9. Spine Stretch:

• Start in an all-fours position. Taking a deep breath, lift your head up and arch your spine downwards.
• As you exhale, lower your head down and arch your spine upward.
• Repeat this movement 10-15 times a day.

10. Prone Arm and Leg Raise:

• Lie on the floor with your face down. Then lift the opposite arm and leg at the same time.
• Stay in this position for 3-5 seconds and then lower it.
• Repeat 10 times on each side.

As a result , proper posture is essential for spinal health and overall comfort. The exercises listed above can help improve your posture. However, it is important to consult your doctor or a physiotherapist before starting any exercise routine. This is especially important if you have an existing injury or health problem. Performing each exercise with the correct technique will help you get the best results and minimize the risk of injury.