An important, and historically significant doctoral thesis by Johannes Büschelberger MD is now available on the IHDI website for review and for use as a research reference. The original thesis was completed in 1961 as part of Dr. Büschelberger’s studies at the University of Dresden. The only known copy was in German language and was housed at the library of the University of Dresden. With cooperation from the Univ. of Dresden, IHDI obtained the original thesis and commissioned translation into English by certified medical translators. Click here to view the document.
Dr. Büschelberger’s thesis profoundly influenced the thinking of many orthopedic surgeons regarding the causes and prevention of infantile hip dislocations. Unfortunately, many of those lessons were lost over time, perhaps because of increasing technology with greater attention to early diagnosis and treatment instead of prevention. The International Hip Dysplasia Institute has placed great emphasis on prevention in addition to finding improved methods for diagnosis and treatment. Thus, the IHDI is pleased to make this fundamental document available for future research into prevention.
The Büschelberger thesis provides a scientific basis for babywearing in the M-position as a key factor in healthy hip development. Dr. Büschelberger carefully evaluated the pelvis, hip joints, muscles and ligaments of twenty-five infants who had expired during childbirth or shortly afterwards. He also studied ancient and modern cultural practices along with review of more than 100 publications in multiple languages dating from the 1700’s to the date the thesis in 1961. His many www.slaterpharmacy.com observations range from description of the true depth of the newborn hip socket (Figure 1) to analysis of the mechanical effects of different muscles on hip development, and to the effect of cultural practices on the frequency of hip dysplasia.
Some key points from Dr. Büschelberger’s 73-page thesis are as follows:
- Unlike the newborn heart, lungs and kidneys, the newborn hip joint cannot be considered a functionally mature structure at the time of birth. It is poorly suited for load bearing or for upright posture. Similar findings are noted in great apes and other primates that maintain their legs in a crouched position until three or four months of age.
- Attempts to straighten the legs, or to encourage the “homo erectus” position cause great pressure on the posterior rim of the hip socket. Due to the length of the femur, a downward force of 100 grams (3 ounces) on the knee creates leverage that produces a dislocating force of 1.0Kg (2.2lbs) at the hip joint.
- “Now the studies of the pelvic specimens showed that bending the femurs by about 110° and the simultaneous abduction of about 40° causes the femoral neck angle to be almost perpendicular to the inlet plane.” Büschelberger also observed that greater flexion of the hips by the newborn allows less abduction with a similar effect for placing the femoral neck perpendicular to the socket.
- “Observations…suggest that the hip joints of the newborn are exclusively adapted to life on the body of the mother.” “After the intra-uterine fetal time, the primate child must still undergo an extra-uterine fetal time on the mother’s body before it reaches the level of maturation attributed to its high organizational level as a ‘nest leaver’.”
- Many factors may initiate hip displacement, but back carrying with the hips flexed and spread promotes healthy hip development during the first year of life. Büschelberger uses the term “breast infant” to describe cultures that carry their babies on the mother’s body compared to “bed infants” where babies are not routinely carried. He reports that hip dysplasia is virtually unknown among “breast infant” cultures “…with mothers carrying their infants during the day, even when working.”
- “Ideal for the prevention of hip dysplasia would be if modern mothers could decide to carry their children around with them, as is their natural disposition.”