Adolescent Hip Dysplasia
What Is Adolescent Hip Dysplasia?
The hip is a ball-and-socket joint formed by the head of the femur (the ball) and the acetabulum in the pelvis (the socket). Normally the femoral head is well covered within the acetabulum and load is spread evenly across the joint surface. In hip dysplasia the acetabulum is shallow and does not cover the femoral head well, so load is concentrated on a small area and the cartilage and labrum at the rim of the joint are overstressed.
Adolescent dysplasia is most often developmental dysplasia of the hip (DDH) that went unnoticed in infancy or early childhood and only causes symptoms later. It can stay silent for years and appear for the first time in adolescence or young adulthood as activity-related hip pain. Left untreated, dysplasia sets the stage for early hip osteoarthritis over time; for general information about hip problems you can review the hip page.
Causes and Risk Factors
Dysplasia results from the acetabulum not deepening enough during the development of the hip joint. Certain factors make it more likely.
- A history of developmental dysplasia of the hip that was missed or incompletely treated in infancy.
- A family history of hip dysplasia or early hip osteoarthritis.
- Female sex, being a first-born child and a breech position at birth.
- Tight swaddling in infancy that holds the legs straight and together.
Symptoms
Symptoms usually begin insidiously and at first appear only with intense activity. Over time the pain can be triggered more often and more easily.
- Pain at the front of the groin or on the side of the hip that increases with activity.
- Pain that worsens after long walking, running or sport and towards the end of the day.
- In some patients, a sense of catching, locking or clicking in the hip.
- A feeling that the hip may give way or is unstable, and stiffness after prolonged sitting.
Conditions That Can Be Confused With Dysplasia
Groin and hip pain has many causes, and examination and imaging tell them apart. In femoroacetabular impingement the problem is not a shallow socket but abnormal contact between the femoral neck and the joint rim, with pinching on flexion and rotation, whereas dysplasia is related to undercoverage and overload.
A labral tear usually accompanies dysplasia or impingement and is rarely the primary problem on its own. Muscle and tendon strains around the groin, hip bursitis and athletic groin pain produce similar symptoms, so the diagnosis is made not by symptoms alone but by imaging that shows the structure of the hip.
How Is It Diagnosed?
Diagnosis begins with the history and physical examination. The range of motion of the hip, the positions that provoke pain and the gait are assessed, and the family history and infancy are reviewed.
- A standing anteroposterior pelvic X-ray is the basic study; it measures how well the acetabulum covers the femoral head.
- MRI is used to assess the labrum and joint cartilage; an accompanying tear and early cartilage damage can be shown.
- In selected cases CT provides detailed bone anatomy for three-dimensional planning.
Non-Surgical Treatment
In patients with mild symptoms and limited loss of coverage, treatment can be managed without surgery. The aim is to reduce pain and to strengthen the muscles around the hip so that load is carried better.
- Activity modification: temporarily reducing the high-impact movements that provoke pain.
- Weight control and a physiotherapy programme targeting the hip and trunk muscles.
- Short-term anti-inflammatory medication under medical advice to manage pain and inflammation.
Non-surgical treatment can ease symptoms but does not change the structure of the shallow acetabulum. Regular follow-up is therefore important in cases where coverage is markedly reduced.
Exercise and Rehabilitation
The aim of physiotherapy is to strengthen the muscles around the hip so that load is shared and the quality of movement improves. The programme is individualised to the patient's symptoms, and movements that increase pain are avoided.
- Strengthening the hip abductors and the muscles at the back of the hip to improve pelvic control during walking.
- Core stabilisation work targeting the trunk and abdominal muscles.
- Range-of-motion and flexibility exercises within the limits of pain.
- Maintaining fitness with low-impact activities such as swimming and cycling.
Exercise is valuable both in managing symptoms and in preparing for surgery when an operation is needed. In advanced dysplasia, however, exercise alone may not be enough, and joint-preserving surgery is then considered.
Surgical Treatment: Periacetabular Osteotomy (PAO)
In young patients with marked dysplasia, ongoing pain and joint cartilage that is still largely preserved, joint-preserving surgery comes onto the agenda. The most commonly used method is periacetabular osteotomy (PAO).
In PAO the bone around the acetabulum is cut so the socket can be rotated into a position that covers the femoral head better; load is then spread over a wider surface and the overload at the rim of the joint is reduced. If a labral tear or impingement is present, arthroscopic repair or correction may be added. The aim of these operations is to reduce symptoms and delay the development of hip arthritis; no method can guarantee that arthritis will never develop.
Recovery Process
After PAO, weight-bearing is restricted for a period to allow the bone to heal; the use of crutches and the gradual increase in load proceed according to the surgeon's plan. Physiotherapy begins early to restore range of motion and muscle strength.
Return to daily activity and sport is guided by criteria such as bone healing and the recovery of muscle strength rather than by a date. Recovery time varies from patient to patient and requires regular follow-up.
The Importance of Early Diagnosis
Because dysplasia relates to bone structure that has already formed, it cannot be prevented entirely; but recognising it early can change the course. Hip screening in infancy and early treatment where needed reduce some of the problems that may appear later.
When dysplasia is recognised in adolescence or young adulthood while the joint cartilage is still preserved, joint-preserving surgical options are broader. Hip pain should therefore not be ignored in people with a family history or who were treated for a hip problem in infancy.
When Should You See a Doctor?
Recognising dysplasia early widens the treatment options while the joint cartilage is still preserved and can reduce the risk of early arthritis.
- You have persistent groin or hip pain in adolescence or young adulthood that increases with activity.
- You feel catching, locking or a sense of giving way in your hip.
- You have a family history of hip dysplasia, or were treated for a hip problem in infancy, and hip pain has started.
To have your hip assessed you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within hip surgery.