Hip Dysplasia Symptoms and Treatment

Hip dysplasia is a condition in which there is either a shallow or deficient hip socket. Some people are born with hip dysplasia (congenital) or they can develop it as they grow (developmental). 

The hip is a “ball and socket” joint. If the socket is not deep enough, the femoral head (“ball”) is partially uncovered. This inadequate support leads to excessive load on the edge of the joint. This can cause injury to the labrum and cartilage around the joint. In addition, the surrounding muscles, tendons and ligaments may be overworked to make up for the shallow socket. As time goes on, this imbalance of forces causes pain in the joint. This pain may increase with activities, or it can progress to pain even when you are at rest.

Hip dysplasia is the most common cause of hip arthritis in patients under 50 years old. It occurs more frequently in women than in men. Early detection and treatment with hip preservation surgery can improve symptoms and quality of life. It can also prevent or delay the development of arthritis.

Hip Dysplasia Symptoms

Pain is the most frequent initial symptom of dysplasia and usually presents during adolescence or young adulthood. Pain can sometimes be felt in the front of the hip or deep in the groin. It can also be felt laterally or even posteriorly (though this is less common).

Pain may be worse with activities or with certain positions and can even lead to a limp. Many patients with hip dysplasia also have some pain at rest and at night — which may interfere with sleep. Some patients also experience a painful snapping sensation which is caused by the iliopsoas tendon.

Diagnosing Hip Dysplasia

The earlier hip dysplasia is diagnosed the better. It is commonly diagnosed in newborns and infants, but many patients are not diagnosed until they are adolescents or adults. Patients who are very active or athletes tend to develop symptoms sooner.

At your first visit to the Hip Preservation Clinic, we will order a special set of X-rays of your hip and pelvis. These X-rays are used to visualize your hip in multiple planes and measure the depth and angle of your hip socket. You will also have a detailed physical exam of your hip to help understand the range of motion and which positions produce your pain. We may also evaluate your spine and overall joint mobility.

If there is concern for hip dysplasia, you may then be sent for advanced imaging such as an MRI or a CT scan, which will show us three-dimensional alignment and allow us to evaluate your labrum and cartilage. Some patients with hip dysplasia may also have a tear of the labrum, which is a ring of cartilage that deepens the socket and acts as a seal for the hip joint.

See a Hip Specialist to Diagnose and Treat Hip Dysplasia

The diagnosis of hip dysplasia can sometimes be missed or delayed. X-rays need to be taken in special positions and interpreting the X-rays requires specialized training and experience. 

Our orthopaedic surgeons have special training in hip preservation is trained to measure multiple areas on a hip X-ray to look for dysplasia.

Hip Dysplasia Treatment

Hip dysplasia in adults that is not treated may worsen and eventually progress to hip arthritis. Once significant arthritis develops, hip preservation surgeries may no longer be an option, and your doctor may recommend total hip replacement.

Physical therapy, pain medication and injections may help manage pain. If these conservative measures fail, we may discuss surgery.

Periacetabular Osteotomy (PAO) to Treat Hip Dysplasia

The surgical treatment of hip dysplasia is a surgery called periacetabular osteotomy (PAO). PAO changes the position of the acetabulum (socket). A series of cuts in the bone mobilize the socket, which is moved to a new position and then fixed in place with screws. The correction needs to be done in multiple planes in order to optimize coverage of the femoral head.

The procedure reduces pain, restores function and prevents further deterioration of the hip joint, thereby increasing the life of the hip joint and avoiding — or postponing — total hip replacement. Patients with progressive cartilage injury and arthritis may not be good candidates for a PAO.

After treatment of hip dysplasia, most patients can expect an excellent recovery and are able to return to high levels of physical activity, including sports. Current data suggests that between 60 and 74% percent of patients have a good outcome at twenty-year follow-up. Preoperative predictors of a poor outcome include advanced age, poor hip function, a limp and advanced arthritis.

When to Have a PAO or a Total Hip Replacement

This is a common question, and it is important to recognize that each patient is unique. The decision whether to try to preserve the natural hip or replace the hip is multifactorial, and includes a complex personalized discussion which takes into account age, activity goals, severity of dysplasia, presence of arthritis and baseline function. You may need to discuss your situation with multiple surgeons. We frequently discuss more complex cases with our multidisciplinary team to help determine the best course of treatment for each unique patient.