Highlighting hip dysplasia

Hip joint conditions are usually associated with older age groups. However, it’s important to recognise that hip dysplasia can occur at any age.

Leading consultant orthopaedic hip surgeon Mr Giles Stafford, highlights the ins and outs of hip dysplasia, providing expert, comprehensive information about the signs to look for, how it is treated and managed, too. 

What is hip dysplasia?

Hip dysplasia is a condition mainly affecting the socket of the hip joint. It is present from birth and is associated with breech presentation, but also often runs in families and therefore has a genetic component, although it is more common in women than men. More severe forms of dysplasia can be picked up at the time of birth, where the midwife checks the baby for buttock asymmetry or ‘clicky’ hips. However, most hip dysplasia is more subtle and often it is not picked up until late teens onwards, depending on how bad it is and the patient’s level of activity.

The main issue with dysplasia is that the hip joint socket in the pelvis is not as deep as it ideally should be. The roof of the socket is also often more upward sloping rather than flat. This allows the ball of the hip to move around more usual. It is no surprise that hip dysplasia is very common in ballet dancers, yoga instructors and gymnasts, as this extra range of movement allows these individuals to obtain extreme positions that others (with more normal hip anatomy) struggle with.

What are the signs or symptoms of hip dysplasia?

Patients with hip dysplasia often present with groin pain (pain felt at deep the top of the thigh) and audible clicking. They perceive the clicking to be coming from the joint itself, but actually usually is from a hip flexor (the psoas muscle) becoming tight and flicking over the hip joint. Patients usually feel (and hear) this when coming out of a flexed position or rotating the hip.

Are the consequences for people who have hip dysplasia if it’s left untreated?

The issue with the milder forms of hip dysplasia is that the hip joint is not as stable as it should be, allowing the ball to slide around more than it should, given the weight that goes through it. This has been termed ‘micro-instability’. The hip is not grossly unstable where the ball can force its way out of the joint (dislocation), but can slide around inside the socket causing increased shear forces that lead to early wear and arthritis (In the more severe forms of dysplasia, the ball may actually be chronically dislocated, but this is usually picked up at birth or early life).

How is it treated and is surgery involved?

If hip dysplasia is picked up as a baby, the usual treatment is placed in ‘double nappies’, or more recently a Pavlik harness. This holds the hips in an ideal position for the socket to grow around the ball and is often very effective. The other extreme is when the dysplasia is not picked up until the patient has developed frank degenerative change, where the only option is a hip replacement. The middle ground is what we normally see, however.

The surgical options in patients with dysplasia really are based around two things, the age of the patient and how much wear there is. If the patient is younger (generally less than 35-40), and the hip looks to be in good condition from the X-rays and MRI, the surgical option is usually a ‘peri-acetabular osteotomy’ (PAO). This is quite a large procedure where the socket is shelled out of the pelvis and rotated round into a flatter position. It is a very large operation (bigger than a hip replacement!), although these days it can be performed through very modest incisions. However, patients who undergo a PAO will often need hip replacements at some point, usually after around 10 years or so.

The grey area of treatment is generally those who present in their late 30s. Because the results of modern hip replacement are so good, and a PAO is a very large operation which buys time, the consensus is that patients over 35 to 40 may be better treated with a hip replacement than a PAO, even if there isn’t significant arthritic change. In these patients, often keyhole surgery (hip arthroscopy) is indicated. This allows the surgeon to assess the hip joint in even more detail, but also to repair some of the damage (such as a labral tear), which may improve symptoms.

What advice to reduce symptoms at home for people living with hip dysplasia?

Despite the above, sometimes it is possible to treat hip dysplasia with specialist physiotherapy to keep the muscles around the hip balanced and strong to help impart more stability to the joint. Joint injections can be effective in reducing the pain for periods of time as well, although this is not a long-term solution to the issue. Impact activities often make the symptoms worse, and therefore general advice would be to avoid a lot of running, but also to avoid pushing the hip beyond the ’normal’ range, as this also may cause damage and pain. Pilates, the elliptical trainer and swimming as well as cycling are usually very useful forms of exercise in those with hip problems.

Are you thinking about treatment for hip dysplasia or other conditions related to the hip? Mr Giles Stafford can provide expert advice. Visit his Top Doctors profile here to arrange a consultation.