Adult Hip Dysplasia
Our hip is the biggest ball-and-socket joint in our body, and under normal conditions, the ball at the upper end of the femur (thigh bone) fits firmly into the acetabulum, the curved portion of the pelvis – the ball is able to rotate freely in the socket, allowing you to move comfortably. However, in certain cases, the socket is not deep enough to hold the femoral head in place, and this condition is known as hip dysplasia.
Overtime, hip dysplasia can end up damaging the tissue that cushions our bones in the joint, known as the cartilage and the tissue surrounding the socket (acetabulum) of the hip joint, known as the labrum. It can also cause pain and issues like an unstable joint or dislocation.
Most patients who have hip dysplasia are born with it (developmental dysplasia of the hip). Hence, doctors will usually check for it in newborns as well as every baby visit until at least a year old. However, there are some rare cases which remain undetected or are mild enough to be left untreated. As such, these patients may not show symptoms of hip dysplasia until they reach adolescence.
Signs and Symptoms
Hip dysplasia in younger patients is usually not painful, however as the child continues to grow, the altered forces in the hip can cause degenerative changes to occur in the articular cartilage and labrum. This can result in the patient feeling pain.
The pain can be especially felt in the front of the groin and it usually comes when you’re doing physical activities. Some patients may also experience discomfort in the side or the back of your hip. Generally, the pain often starts out mild and may happen occasionally; overtime it can become more intense and frequent, with almost half of the patients with hip dysplasia experiencing pain at night.
Patients with hip dysplasia may also experience the feeling of locking, catching, or popping within the groin.
Causes and Risk Factors
Hip dysplasia tends to run in families, with girls having a higher risk of developing this condition. It shows up in babies more often because the hip joint is made of soft cartilage when you’re born, and over time, it’ll harden into bone. It is during this period that the ball and socket help to mold each other, therefore, if the ball is not fitting properly into the socket, the socket may become too shallow and thus not forming completely over the ball.
There are some reasons why this can happen:
- It’s the mother’s first pregnancy
- The baby is large, or if there’s too little amniotic fluid in the sac throughout the pregnancy, resulting in the baby experiencing limited movement.
- The baby is in the breech position – the rear instead of the head is toward the rear canal.
All these factors contribute to the reduction of space in the womb, making things crowded for the baby. As such, this results in the ball moving out of its proper position.
Diagnosis
During the physical examination, the doctor or orthopaedic specialist will discuss the patient’s medical history and symptoms. They will also check the mobility in your hip and perform something known as an impingement test – they will flex your hip and twist it toward the middle of your body. If you have hip dysplasia, then this should cause a pinching feeling or sensation.
Apart from physical examination, if your healthcare provider suspects that you have hip dysplasia, they may suggest you go for certain imaging tests like an MRI, X-ray, or CT scans.
X-rays: X-rays provide images of bone to help your doctor assess the alignment of the acetabulum and femoral head. Performing an x-ray can also help determine the presence of arthritis.
Computerized tomography (CT) scans: A CT scan is more detailed than an X-ray and can help your doctor determine the severity of your dysplasia.
Magnetic resonance imaging (MRI) scans: These scans show better images of the body’s soft tissues, allowing your doctor to check if there’s any damage to the labrum and articular cartilage.
Treatment
The goal of treatment for hip dysplasia focuses on delaying or preventing the onset of osteoarthritis whilst still preserving the natural hip joint for as long as possible. Your natural hip joint will always give you better mobility and a higher activity level than a joint that has undergone replacement surgery.
If you have mild hip dysplasia, then your doctor may recommend conservative (nonsurgical) treatment options.
Some of these include:
- Observation
If you have minimal symptoms and no damage to the labrum or cartilage, your doctor may recommend you to simply monitor the condition to ensure it does not get worse.
- Lifestyle Changes
Your doctor or orthopaedic specialist may also recommend you avoid doing activities that may cause pain or discomfort. If you are overweight, then your doctor may recommend you lose weight so that the pressure on your hip joint will be reduced.
- Physical Therapy
Specific exercises can help to improve the range of motion in the hip as well as strengthen the muscles supporting the joint. In turn, this relieves some stress on the injured labrum or cartilage.
- Medications
Your doctors may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the pain and reduce swelling in an inflamed joint or labrum. Furthermore, injections, such as cortisone, into the hip joint can help to reduce inflammation and improve symptoms. However, the effects of these medications are often temporary.
Only in severe cases where the patient is experiencing pain and has significant damage to the labrum or articular cartilage in his or her hip then will surgery be recommended. The most common surgical procedure used to treat hip dysplasia is hip osteotomy – orthopaedic surgeons will reshape and reorientate the acetabulum and/or femur to allow the two joint surfaces to be at a more normal position. This surgical treatment has been proven to prevent or delay hip arthritis that may result from dysplasia. In mild hip dysplasia with a labral tear, it may be possible to perform a keyhole (arthroscopic) hip procedure to repair the labral tear with good results, but this requires careful evaluation by your doctor with regards to suitability.
In advanced cases, when the cartilage or labral damage has progressed beyond repair, it may be necessary to perform a total hip replacement. Hip replacements can greatly reduce the pain and disability arising from hip arthritis, and allow you to improve your quality of life.
Every case is different; hence it is best to consult an orthopaedic surgeon for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you are suffering from hip dysplasia and let us help you enjoy a better quality of life.
