Hip Dysplasia

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In an attempt to keep things interesting and varied in our physiotherapy blog, I thought we would again move onto something completely different: this time a look at a very difficult to diagnose condition and one that if left untreated tends to cause large problems for patients in later life: hip dysplasia.

What is Hip Dysplasia?

Before talking about exactly what hip dysplasia is I think we probably need to cover a little bit of hip and pelvic anatomy. As physiotherapists it is all too easy to think that everyone knows what the hip looks like and the structures involved.

The hip is a ball and socket joint which is comprised of the femur which forms the ball and is the largest bone in the body and also the pelvis which forms the socket which is called the acetabulum. It is an amazing joint and allows a large range of motion whilst still supporting the whole body! In a normally developing person the socket of the hip (acetabulum) forms in a such a way and in such an angle that the ball is well supported and does not slip out.

However in some patients the acetabulum (socket) forms with a shallow angle (i.e. instead of being a deep socket it is flatter/shallower) and this can lead to the ball not being supported in the socket and tending to move around more than is good. This is called acetabular hip dysplasia and due to the movement of the ball in the acetabulum it causes pain and osteoarthritis. In infants the condition is well understood and is called developmental hip dysplasia and is usually picked up very early and treated well. However in adults it is very difficult to diagnose and if not picked up can lead to early arthritis and hip replacements.

What are the Symptoms of Hip Dysplasia?

The symptoms of hip dysplasia in adults will usually involve some form of hip, groin or thigh pain. A patient may describe pain when squatting down or sitting for extended periods and occasionally it will refer pain into the knee. Often someone with hip dysplasia will have a long history of hip and groin pain that has been going on since they were very young.

How is Hip Dysplasia Diagnosed?

Unfortunately, actually diagnosing acetabular hip dysplasia is no easy task. Often patients who have hip dysplasia are young, physically active and it is all too easy to diagnose this as femoroacetabular impingement and miss the chance to get an early diagnosis of acetabular hip dysplasia and early access to the most appropriate treatment. Ideally it is diagnosed at a young age and managed straight away, however for many people this will not be the case and they will only receive a diagnosis of hip dysplasia later in life. It is usually diagnosed at this point when a patient's pain and symptoms have become severe and they have a hip x-ray which then shows the angle of the socket to be too shallow. 

Who is Likely to Have Hip Dysplasia?

Although anyone can get hip dysplasia, research shows that patients with hip dysplasia are most likely to be female, young , have a family history of early hip disease, be very physically active and also on questioning be able to describe a pattern of hip niggles throughout childhood.

Why is Hip Dysplasia a Problem?

Not all conditions of the hip and groin are significant or likely to lead to problems later in life but hip dysplasia if not identified and treated early can have significant cosequences later on in life. As the socket is too shallow to keep the ball securely in the joint this leads to increased pressure being placed on the cartilage and the fibro-cartilage of the labrum. Eventually this increased pressure causes wear points in the cartilage and inflammation of the joint which in turn leads to osteoarthritis and eventually the need for a very early hip replacement. 

Treatment for Hip Dysplasia

The treatment for hip dysplasia will very much depend upon whether or not it is diagnosed at a very young age in which case it is called Developmental Hip Dysplasia or if it is diagnosed much later in life. First we will look at the treatment options for a baby born with Developmental Hip Dysplasia:

1. Harness: if diagnosed very early a special type of harness called a Pavlik Harness will be prescribed which will maintain the baby's hip and legs in a specific position. More information is available here on the NHS site: https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip/

2. Surgery: should the harness not work or potentially the diagnosis was made too late then surgery is the usual next step for hip dysplasia and involves putting your baby under general anaesthetic and wearing a cast at the hips. Sometimes fuerther surgery called an osteotomy is required to correct any issues with the bone.

Treatment for adults diagnosed with hip dysplasia will likely involve the following process:

1. An assessment and diagnosis via X-Ray and a subsequent consultation with an orthopaedic surgeon to discuss treatment options. If the socket is not too shallow it is possible that the surgeon will recommend physiotherapy and strengthening. However if the socket is too shallow then surgery will likely be the only option.

2. Surgery: this will usually involve a specialised hip operation called periacetabular osteotomy (PAO) which needs to be done before the joint becomes too worn and therefore an early diagnosis is vital for a successful outcome. This will attempt to deepen and re-align the socket so that the ball sits better and has less of a wearing effect on the joint.

3. Physiotherapy: after having the PAO it is vital that the patient accesses good physiotherapy in order to strengthen the muscles, ligaments and tendons of the hip and make the best possible recovery.

4. Total Hip Replacement: if the diagnosis is made too late then it is possible that too much damage will have been made to the joint and a hip replacement will be the only option.

Personally as a physiotherapist what I take away from this and try to use in my own clinical practice is that it is important to keep an open mind when seeing younger patients with hip pain and be open to the possibility that they may have dysplasia. I think it is fairly clear from the article above that early diagnosis is vital for anyone with hip dysplasia because if treated early then this will reduced the likelihood of surgery in later life and a potential need for a hip replacement due to arthritis.  More information can be found here http://www.csp.org.uk/frontline/article/clinical-update-acetabular-hip-dysplasia-physios-role

Okay, I hope that you have enjoyed reading this blog about hip dysplasia, if you would like anymore information about this then please get in touch. For anyone reading this blog for the first time we are a home visit physiotherapy service based in Lichfield and serving surrounding areas such as Sutton Coldfield, Tamworth, Rugeley, Cannock and Walsall.