Hip Dysplasia is a hip joint disorder that patients are typically born with and can progressively worsen over time. The hip is a ball and socket joint. The socket is the part of the hip bone called the acetabulum, and the head of the femur is the ball. Articular cartilage covers both the ball and the socket and functions to reduce friction for smooth joint movement. In a healthy hip, the ball of the femur fits perfectly into the acetabulum. However, in individuals with hip dysplasia, the femoral head either does not line up properly with the contour of the socket, or in other cases, the socket is too shallow to support the femoral head in place. The shallow socket of the acetabulum results in partial or complete dislocation of the femoral head, which can have devastating effects on the cartilage over time. Hips with dysplasia tend to wear out faster than normal shaped hips, leading to progressive destruction of the articular cartilage and arthritis.
Hip dysplasia occurs when the acetabulum fails to fully cover the femoral head, leading to a shallow hip socket. Most individuals with hip dysplasia are born with the condition. Approximately 1 in 10,000 babies are born with hip dysplasia and females and first-born children are more likely to have it. Hip dysplasia can be caused while in the womb by increased pressure on the hips during development. First pregnancy, large baby, and breech position (abnormal baby position in the womb) are all risk factors that reduce the amount of space and increase the pressure within the womb. Hip dysplasia may also be genetic, meaning passed down in families.
Symptoms of hip dysplasia may present at different stages of life. In infancy, hip dysplasia may present with unequal leg lengths. The affected hip may also be less flexible than the other during diaper changes. Once the child learns to walk, they may develop a limp on the affected hip. In young adults, hip dysplasia may cause tears to the labrum or early stages of arthritis. Symptoms that adolescents and young adults may experience are the following:
During your consultation with Dr. Bryan Penalosa, a Chicago sports medicine surgeon and hip dysplasia specialist, your medical history, hip dysplasia symptoms, and past injuries will be reviewed.
Physical Exam
He will conduct a physical examination checking range of motion including flexion, adduction, and rotation to diagnose your hip impingement. The hip impingement test will also be performed during your physical exam. This is a test in which Dr. Penalosa will ask you to bring your knee to your chest while he rotates the knee in toward the opposite shoulder (FADIR [flexion, adduction, and internal rotation]). If the hip impingement test causes pain, you likely have a hip labral tear. There may be a sensation of instability or micro-motion inside the hip joint that can lead to overload of the cartilage, muscles, and tendons around the joint. A comprehensive physical exam is key to determine the cause of your hip pain, as it can indicate if the ball fits properly within the socket.
Imaging
Diagnostic imaging is necessary to definitively diagnose hip dysplasia and a possible associated labral tear. X-rays will reveal less coverage of the hip ball (the socket can be very shallow), and an MRI will reveal damage to the soft tissue, such as the labrum (a hip labral tear) and/or the cartilage, which can be affected from instability or overload. A CT scan is typically ordered to learn details about the shape of the bones, location of any abnormal bone growth, and the rotation of the bones.
Hip Injection
An intra-articular hip injection can help confirm the diagnosis of symptoms associated with hip dysplasia. This injection will be performed in the office at the time of your visit under ultrasound guidance. If the majority of your pain goes away, even temporarily, following the injection, it confirms that the source of the pain is due to intra-articular hip pathology.
Some people live active lives, never knowing they have hip dysplasia and don’t have any hip pain. By the time symptoms develop, there is usually some damage to the hip labrum and with repeated use, the damage may progress. In mild to moderate cases, hip dysplasia pain can initially be treated without surgery.
Non-operative treatment of hip dysplasia involves a change in activities to avoid movements that cause hip pain, including taking time off from activities that cause hip pain, using over-the-counter anti-inflammatory medications to reduce pain and inflammation, and physical therapy. Typically, symptoms will resolve within several weeks of conservative, non-surgical treatment. A steroid injection can also help relieve hip pain. If your hip pain and any instability are resolved with non-operative treatment and you are able to return to your desired level of activity, then no hip dysplasia surgery is needed.
When nonsurgical hip dysplasia treatments do not relieve hip pain and imaging confirms hip dysplasia with an associated hip labral tear, hip surgery is a reasonable option.
Typically, the surgical treatment for hip dysplasia with an associated labral tear includes a 2-stage procedure. Initially, a minimally invasive procedure called hip arthroscopy is performed. Hip labral surgery is usually an outpatient procedure, and you will go home the same day. During your hip labral surgery, Dr. Bryan Penalosa will repair the labral tear and remove any abnormal bone growth causing hip impingement. On rare occasions, more commonly associated with revision hip surgery, a labral reconstruction may be indicated. Surgery typically lasts about 1-2 hours. Hip surgery is customized for each patient based on each patient’s unique hip anatomy and hip condition.
About 10-14 days following the hip arthroscopy with Dr. Bryan Penalosa, an osteotomy procedure is performed. Periacetabular osteotomy (PAO) is the term used for an osteotomy of the hip socket most commonly used for this condition. PAO surgery involves removing a segment of bone from the hip socket and positioning it in a location that will better support the femoral head during walking and activities of daily living. The bone is secured in place with screws until it fully heals.
The recovery time after hip surgery with labral repair can vary depending on several factors, including the extent of the surgery, individual patient characteristics, and the level of activity that the patient is striving to return to. When paired with a PAO, it takes about 2 months after PAO surgery for the patient to be able to fully weight bear on the operated hip. Full recovery following hip dysplasia surgery is typically around 7-9 months.
Hip preservation refers to the use of procedures to protect and maintain the labrum (the cartilage that lines the hip bone to deepen the hip socket) to prolong the natural lifespan of the hip, prevent arthritis of the joint, and to avoid or delay hip replacement surgery. Hip dysplasia predisposes to premature joint degeneration.
Untreated hip dysplasia can indeed lead to long-term complications, and one of the potential consequences is the development of hip arthritis. Here are some of the long-term effects of untreated hip dysplasia:
Hip dysplasia involves lack of support to the femoral head due to under coverage. Over time, this repetitive mechanical stress can lead to the gradual wear and tear of the hip joint tissues, including the cartilage lining the joint.
As hip dysplasia persists, the friction within the hip joint can damage the articular cartilage, which provides a smooth surface for joint movement. This cartilage damage can result in hip pain, joint stiffness, and decreased mobility.
Perhaps one of the most concerning long-term effects of untreated hip dysplasia is the development of hip osteoarthritis. The gradual wear and tear on the joint’s cartilage and other structures can eventually lead to arthritis, characterized by pain, inflammation, joint deformity, and reduced mobility.
Hip dysplasia can cause the labrum, a ring of cartilage that lines the hip socket, to deteriorate over time. A damaged labrum can contribute to hip pain and instability.
Untreated hip dysplasia can increase the risk of developing secondary hip conditions, such as tendinitis, hip bursitis, and muscle strains, due to altered hip mechanics and abnormal loading of the joint.
It’s important to note that not everyone with hip dysplasia will progress to hip arthritis or develop long-term effects of hip dysplasia, and the rate of progression can vary widely among individuals. However, addressing hip dysplasia early through conservative treatments or surgical intervention can help reduce the risk of these long-term complications and improve hip joint function and overall quality of life.
