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 ball part of the joint is not held securely in place. The surrounding muscles, tendons, ligaments, and other soft tissue structures can work to make up for the shallow socket. 

As time goes on, those structures get tired and can start to fail. When this happens, the hip usually becomes sore and painful. The pain may increase with activities, or it can progress to where there is pain even at rest. 

Hip dysplasia in adults is the most common cause of hip arthritis in young women. Men also have hip dysplasia and account for approximately one in five cases. Early detection can prevent some total hip replacements through modern techniques of hip preservation surgery.

Hip Dysplasia Causes

When babies are born, the nurses and doctors do specific exam tests to check for loose hip joints. The hips are checked and moved in various positions. Hip instability in babies can usually be detected, but one possibility is that some babies have shallow sockets that fail to develop completely or become unstable at an older age. This makes it hard for doctors to diagnose all cases of hip dysplasia. 

Some known risk factors for hip dysplasia are first born babies (not as much room), girls (more ligament laxity), positive family history and the breech position that stretches the hips. 

Other causes of hip dysplasia may be related to how the baby is held and swaddled after they are born. New swaddling techniques have been recommended to help keep baby’s hips in a healthier position as they develop.

Hip Dysplasia Symptoms

During adolescence or adulthood, the most common first sign is pain in the hip. Most people think of the hip as the bone that protrudes on the upper side of the thigh. However, the hip joint itself is in the middle of the groin where the thigh joins the body. This is where the hip bends and straightens. 

Pain in the front of the hip, thigh, or groin that is aching and becoming worse over a period of several months raises concern about undetected problems with the hip joint. Sometimes painful snapping occurs deep in the hip. This is different from snapping of the muscles on the side of the thigh where the muscles roll across the bump on the side of the upper thigh (that is outside the hip joint but is a common location for snapping bursitis). 

When the snapping is deep in the hip joint, then there may be something torn inside the joint itself. Sometimes patients may feel pain in the gluteal muscles or buttock region.

Diagnosing Hip Dysplasia

The earlier hip dysplasia is diagnosed the better. It is commonly diagnosed in newborns and infants, but some patients go undetected until later. Patients who are very active tend to become symptomatic sooner. Patients who aren’t as active tend to show symptoms later in life. 

When patients are first evaluated for hip pain, we first take special X-rays that we then use to measure the angles of your ball and socket. We then do various physical exam maneuvers to evaluate your hips. We may also evaluate your spine and overall joint mobility. 

Some patients with hip dysplasia may also have a tear of a piece of cartilage in the hip joint called the labrum. The labrum deepens the hip socket and acts as a seal for the hip joint. Because patients with hip dysplasia tend to have an unstable joint, extra stress is put on the labrum. The extra stress can weaken the labrum and cause it to tear.

Importance of Seeing a Hip Specialist to Diagnose and Treat Hip Dysplasia

Hip dysplasia is often misdiagnosed because the X-rays need to be taken in special positions. Hip dysplasia that is borderline or mild can also be missed if the person looking at the X-ray is not familiar with reading hip X-rays for dysplasia.

An orthopedic surgeon who has special training in hip preservation is trained to measure multiple areas on a hip X-ray to look for dysplasia. This type of training is typically done during specific hip preservation training after their general orthopedic training is complete.

Hip Dysplasia Treatment

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

Physical therapy, pain medication and injections may help manage pain. If these conservative measures fail, another option is to have the hip joint re-aligned so that the pressures on the joint surface are spread over a wider area — a periacetabular osteotomy. The surgery must be done before the joint surface becomes too worn out. Early hip preservation surgery with a PAO can postpone a joint replacement surgery for many people.

Periacetabular Osteotomy (PAO) to Treat Hip Dysplasia

Periacetabular osteotomy is a surgical procedure to rotate the acetabulum (socket) to a better position to improve coverage of the femoral head. A series of cuts in the bone around the acetabulum is performed to allow for a freely-mobile acetabular segment. Once re-positioned, the acetabulum is secured back to the pelvis with screws. If a patient also has a labral tear in their hip, another procedure can be done to fix the tear and reshape the ball and neck of the femur bone.

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.

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, limp, and advanced arthritis.

Advantages of a PAO Over Total Hip Replacement

That’s a common question that doesn’t always have a clear answer because each patient is different. The decision whether to try to preserve the natural hip or replace the hip completely depends on the presence of arthritis, severity of dysplasia, and expected activity level after surgery. Your doctor is the best person to discuss the specifics of your particular situation. If your doctor primarily does total hip replacement and hasn’t done any PAO surgery, then a second opinion from a qualified PAO surgeon is a good idea. On the other hand, if your doctor treats children and young adults but rarely does total hip replacements, then an opinion from a total hip surgeon may be worthwhile.