So what is Hip Dysplasia? And What do we do about it?

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1 So what is Hip Dysplasia? And What do we do about it? What is Hip Dysplasia? The bones of the hip joint are not properly aligned. It is an abnormality to the stability and or shape of the joint (the ball and socket). The socket may be too shallow, and the ligaments too loose, which causes the femoral head (ball) to slip in and out partially or completely. It puts abnormal stressors on the joing and prevents the joint from functioning normally, and causes the hip joint to wear out much faster than normal.. Think of a car s tires and how they wear out faster when the car is out of alignment. Pain is not normally felt until much later stages, a silent condition if you will, and thus makes the condition harder to detect and more difficult to treat the more time that passes. Despite the frequency of the condition, awareness of the condition and the fact that it can potentially result in life- long disability, is poor outside of the medical profesion. How common is hip dysplasia? Hip dysplasia affects thousands of people each year from newborns to adults. It is the most common hip deformity in children. About 2-3 out of every 1000 infants require treatment. Hip dysplasia is the single leading cause of osteoarthritis in young and older adults, which more often than not leads to total hip replacements. Despite how common the condition is in our population the wide age range poses some difficulties in understanding. Who does it affect? Thousands each year from newborns to young and older adults. See the following pages for more on the characteristics, diagnosis and treatment. Who is most at risk? As stated by Boston Children s Hospital Orthopaedic Hip Program: - Children, where there is a genetic predisposition - Females- who have looser ligaments than males - First borns- whose fit in the uterus is tighter than in later babies - Breech babies- whose constrianed position tends to strain the joints ligaments What causes hip dysplasia? Genetics are thought to play a roll, but there is A LOT more research to be done in this area, which will also help us to develop better ways of detecting hip dysplasia and also better, more effective, less invasive ways of treating the condition. What abnormalities characterize hip dysplasia? As stated by Boston Children s Hospital Orthopaedic Hip Program: - Ligaments that are too loose - Inadequate development of the hip socket - A hip socket that s shallow: dish shaped rather than cup shaped - A hip socket where the upper portion is tilted outwards rather than the normal horizontal orientation

2 How is it diagnosed and treated? Please see the next few pages for Child (pg 3) and Adult (pg 4-5) information! Hip dysplasia can have potentially severe physical and mental repercussions. Patients struggle to overcome both aspects constantly from pre diagnosis, diagnosis, throughout treatment and after the fact. The Hip Hop 5K has been created to potentially aid in finding better, more efficient methods of diagnosis, less invasive forms of treatment, and to aid the IHDI and Boston Children s Hospital Hip Program in any areas of hip dysplasia research and treatment that they see fit to make the diagnosis, treatment, outcomes and overall life impact on a patient better. All information in this document has been obtained and simplified from the IHDI and Boston Children s Hospital.Please see Boston Childrens Hospital Othopaedic Hip Program ( and the IHDI ( for more resources and in- depth explations on hip dysplasia. This document, and any of the resources noted here from Boston Children s or the IHDI do not take the place of a medical consult. Please make sure that you take the time to familiarize yourself with this information, but seek out the appropriate medical treatment.

3 Babies and Kids What causes babies and children to be born with or develop hip dysplasia? - This is still under a lot of research, but it is thought that genetics could play a role. - Loose hips around the time of birth (most common cause) - This is usually due to the normal hormones that help relax ligaments to help make childbirth easier. - Some hip instability is very common in newborns. Hip dysplasia that requires treatment occurs in about 2-3 out of every What are the signs to look for in a child with hip dysplasia? There are different signs of hip dysplasia depending on the child s age and stage of development. As stated by the hip prorgam at Boston Children s: - The leg on the side of the dislocated hip may appear shorter - The leg on the side of the dislocated hip may turn outward - The folds in the skin of the thigh or buttocks may appear uneven - The space between the legs may look wider than normal How is childhood hip dysplasia diagnosed? - Can be detected at birth, but can almost always can be diagnosed with ultrasound screening (a non invasive test, performed only selectively to those highly at risk or suspected of hip dysplasia at this point in time). - A pediatrician or neonatologist does an initial hip dysplasia screening with gentle manipulations, but unfortunately often the condition is not detectable until later. - A child that is older than 6 months can be diagnosed by x-rays done with specific views of the hip and pelvis. This method is the more reliable after 6 months of age. - X-ray as well as MRI, CT and MR Arthrogram may be used in older children What are the treatment methods? - A clinical consultation is very important, and sometimes you may need to seek out several opinions - Non- Surgical Treatment methods include: - Pavlik Harness, Hip Aduction Braces, and Traction - Surgical Treatments include: -Closed or Open reduction - Pelvic Osteotomy - Femoral Osteotomy - See the Boston Childrens Hip Program and the IHDI for more detailed information on these treatment options. What if it goes untreated? From the IHDI and Boston Children s Hospital: If treatment is delayed beyond 2 years of age, hip deformity can lead to painful hips, waddling walking and a decrease in strength. If untreated altogether, osteoarthritis (a painful hip disorder) and other hip deformities can develop in young adulthood. Premature arthritis results in pain and disability. If a child who has hip dysplasia remains relatively pain-free, parents may sometimes be tempted to leave their child s diagnosed condition untreated. But even if a child who has DDH grows to adolescence without developing pain or a limp, it s inevitable that her untreated dysplastic hip will wear out and become arthritic in adulthood. Parents need to understand that sometimes DDH treatment in childhood is prophylactic (preventive) to prevent serious hip disease and possible disability later on.

4 Young Adults and Adults What causes adults to have hip dysplasia? As stated by the IHDI, The cause of adolescent and adult hip dysplasia is obscure. Doctors are just becoming aware that infant screening detects only 10% of dysplasia that causes arthritis in adults. 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. These would not be detected by current methods. The known causes of hip dysplasia are mainly related to loose hips around the time of birth, with the risk factors stated earlier (genetics, female, first born, breech) coming into play. It is present in both men and women. Why was it not detected as a kid? Current methods of screening are inadequate; about 90% of the young adult cases are not diagnosed in childhood by the current methods of screening. We clearly need to develop not only better means of detection but also treatments for the condition. People with milder cases of hip dysplasia often go through childhood and adolescence without experiencing symptoms or even knowing about their condition. But in young adulthood, they may start having hip pain and need to seek medical care. Doctors are finding that hip dysplasia can develop after infancy and show up in the adolescent years, young adulthood and adult years causing potentially severe problems. What are the signs to look for in an adult where hip dysplasia is suspected? - Pain in the hip (most common first sign) - Pain or snapping in the front region of the hip - Aching or pain in the groin area (becoming worse over a period of several months) - Painful snapping deep in the hip - Feeling of instability, slipping or catching within the joint Should I seek treatment for mild- severe adult hip dysplasia? If the condition is not treated, it will worsen and eventually require a total joint replacement. There are few temporary fixes and they will not help long term. Surgery on the joint must be done before the joint becomes too worn out to heal. Putting up with the pain as long as possible is rarely the best course of action to take in the case of hip dysplasia. Early hip preservation surgery can postpone a total hip surgery in many people under 50 years of age. Hip dysplasia is often misdiagnosed because the x-rays need to be taken in special positions. The average delay in proper diagnosis is 3 years because the methods of diagnosis are somewhat new to many physicians. What are the consequences of hip dysplasia? Hip dysplasia is the most common cause of osteoarthritis, more often than not leading to hip replacements. It is a painful, disabling condition, that involves the breadown of joint cartilage and the inflamation of the joint. Approximately 35,000 of the total number of hip replacements performed in the US each year because of hip dysplasia. Early detection can prevent some total hip replacements through modern techniques of hip preservation surgery, but we need better methods of detecting it sooner rather than later. In many cases of moderate to severe hip dysplasia, the condition affects a person s daily life considerably before they have even reached the later stages of osteoarthritis. There is a potnetial for life long disability caused by hip dysplasia, not to mention the emotional struggle for the patient and those around them.

5 Young Adults and Adults (Cont.) How is adult hip dysplasia diagnosed? - Using x-ray you can usually diagnose hip dysplasia, and the degree of severity - MRI (can give information on damage to the cartilage and labrum in the joint), CT, MR Arthogram and Ultrasound may be used in some cases under certain conditions How is adult hip dysplasia treated? Hip dysplasia is treated differently depending on the age of the patient and the stage of growth/ development in life that they are in. This is a very general outline. Detail on all this can be found on Boston Children s Hospital Hip Program website and the IHDI. Treatment of young adult and adult hip dysplaysia is different from that of newborns, infants and pre- pubescent children. - Non- surgical Treatment Options: - Physical therapy (to strengthen muscles) - Activity restriction - Pain medication/ anti- inflammatories - Surgical Treatment Options: - Arthroscopy: is a technique for treating secondary problems inside the hip. An arthroscopy alone cannot correct the main problem of the abnormal orientation of the acetabular rim in dysplasia. Realignment operations such as the periacetabular osteotomy (PAO) can correct the important rim tilt problem. - Periacetabular Osteotomy (PAO): A periacetabular osteotomy or PAO is considered to be the preferred surgical cor rection of acetabular dysplasia. This procedure preserves and improves the function of the patient s own hip joint rather than replacing it with an artificial one. The goal of the PAO is to reduce or eliminate pain, restore function, and maximize the functional life of the dysplastic hip. - This involves cutting the acetabulum free, and then repositioning it to a more stable alignment and screwing the created fragment into place. - Hip resurfacing or a hip replacement in some cases that are too far damaged, jeopardiing the success of a PAO Related Conditions? - From the IHDI, Hip pain can be caused by several different problems. Pain that aches during standing, walking, or general daily activities may be due to thinning or wearing out the joint surface itself. This is commonly known as osteoarthritis. Pain with certain movements that is sharp, catching, or has a snapping sensation may be caused by trochanteric bursitis, labral tear, impingement or sometimes from instability in the joint itself. - Trochanteric bursitis: - Pain on the outside of the hip, may be from muscles rubbing on the trochanter. Could feel like something is snapping in and out of place on the side of the hip. Common cause of hip pain, generally treated conservatively (non-surgically). - Torn labrum: - The labrum is a soft edge around the socket and is easily damaged in a shallow or instable hip. - Pain that is sharp, stabbing or has a catching sensation in certain positions may be due to a torn labrum or an impinge ment. Sometimes a torn labrum will make a loud clicking noise. - Impingement (FAI): - Impingement is not usually caused by dysplasia, but it can be painful. The pain is more like a pinching pain in certain positions of sitting or hip movement like a high kick when dancing. Impingement is usually caused by an abnormal shape of the neck of the femur just below the head. It can also be caused by a socket that is too deep.