Hip Dysplasia

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In this blog we will be continuing looking in more depth at individual causes of hip pain. We have previously covered gluteus medius tendinopathy and hip arthritis and in this blog we will examine hip dysplasia.

Before looking at how physiotherapy might be able to help with hip dysplasia we first need to have a look at exactly what it is and some anatomy.

What is Hip Dysplasia?

Hip dysplasia refers to a condition where the hip joint fails to develop normally, resulting in improper alignment and instability. The hip joint consists of the acetabulum (hip socket) and the femoral head (the ball at the top of the femur). In hip dysplasia, the acetabulum may be too shallow or poorly formed, making it difficult for the femoral head to fit snugly within it. This lack of stability can lead to hip joint dislocation, pain, and other complications.

What are the Symptoms of Hip Dysplasia?

The symptoms of hip dysplasia can vary depending on the age group affected and it presents differently in infants, children, and adults. It's essential to recognize the signs early to seek proper medical evaluation and intervention.

Infants (0-1 year):

• Limited Range of Motion: Infants with hip dysplasia may have limited movement in one or both hips. They might have difficulty moving their legs outward or bringing their knees together.
• Clicking or Popping Sounds: You may notice clicking or popping sounds coming from the hip when the baby moves their legs, indicating instability in the joint.
• Asymmetrical Thigh and Gluteal Folds: The skin folds on the thigh and buttocks may appear uneven or asymmetric due to the dislocated hip.
• Leg-Length Discrepancy: One leg may appear shorter than the other due to the abnormal positioning of the hip joint.

Children (1-10 years):

• Limping: Children with hip dysplasia may develop a limp when walking or running due to the discomfort and instability in the hip joint.
• Abnormal Gait: They may exhibit an unusual waddling gait, with their feet turned outward to compensate for the instability in the hips.
• Leg-Length Discrepancy: The condition can lead to one leg being shorter than the other, affecting the child's posture and balance.

Adults (10 years and above):

• Hip Pain: Adults with hip dysplasia may experience pain in the hip or groin area. This pain can vary in intensity and may worsen during physical activities or after prolonged periods of sitting or standing.
• Stiffness: The affected hip may feel stiff and limited in movement, reducing the individual's ability to perform daily activities comfortably.
• Difficulty Walking: Hip dysplasia can impact walking patterns, leading to an altered gait and reduced mobility.
• Increased Pain with Activity: Physical activities, such as walking, running, or climbing stairs, can exacerbate hip pain in individuals with hip dysplasia.
• Hip Instability: A feeling of instability or "giving way" in the hip joint may be present due to the improper alignment and lack of support.

It is important to note that some individuals with hip dysplasia may not experience any noticeable symptoms, especially in mild cases. However, early detection and intervention are crucial to prevent further complications and maintain hip joint function. If you suspect hip dysplasia or experience any of the above symptoms, consult a healthcare professional for a thorough evaluation and appropriate management.

Who Can Get Hip Dysplasia?

Well Hip Dysplasia can affect people of all ages and genders but some factors make having hip dysplasia more likely. Below is a breakdown by age of who is most likely to get hip dysplasia

1. Infants:
   • Female Infants: Hip dysplasia is more common in female infants than in males.
   • Family History: Babies with a family history of hip dysplasia have a higher risk of developing the condition.
   • Breech Presentation: Babies born in a breech position (feet first rather than head first) are at increased risk of hip dysplasia due to the limited space in the womb affecting hip development.
2. Children and Adolescents:
   • Female Gender: Females are more prone to hip dysplasia during their growing years.
   • Family History: A family history of hip dysplasia or a genetic predisposition increases the risk.
   • Hormonal Factors: Hormonal changes during puberty can impact the development of the hip joint, potentially contributing to dysplasia.
3. Adults:
   • Females: Adult females are more likely to develop hip dysplasia than males.
   • Genetic Predisposition: Having a family history of hip dysplasia can elevate the risk.
   • Structural Abnormalities: Individuals born with structural abnormalities in the hip joint are at higher risk.
   • Developmental Dysplasia in Childhood: Those who had untreated or inadequately managed hip dysplasia in childhood may develop long-term hip problems as adults.

What Causes Hip Dysplasia?

This is very much the subject of research and the exact causes of Hip Dysplasia are not clear and it is likely that a range of genetic and environmental factors contribute towards the development of hip dysplasia:

1. Genetics: There is a strong genetic component to hip dysplasia. If there's a family history of the condition, the risk of a child developing hip dysplasia is higher. Certain genes may predispose individuals to have poorly developed hip joints.
2. Breech Birth: Babies born in the breech position (feet first instead of head first) are at a higher risk of developing hip dysplasia. The position of the baby in the womb can affect the development of the hip joint.
3. Gender: Hip dysplasia is more common in females than males. It's not entirely clear why, but hormonal and structural differences may play a role.
4. Hormonal Factors: Hormonal changes during pregnancy can influence the development of the hip joint in the fetus. This is why hip dysplasia is more common in the firstborn child, as hormonal levels can be different in first pregnancies.
5. Environmental Factors: Certain environmental factors can contribute to hip dysplasia, such as swaddling a baby's hips too tightly or using carriers that position the baby's legs unnaturally. These factors can impact the proper development of the hip joint.
6. Other Medical Conditions: Certain medical conditions, such as connective tissue disorders like Ehlers-Danlos syndrome, can increase the risk of hip dysplasia.
7. Joint Laxity: Some individuals have naturally looser joints, which can increase the risk of hip dysplasia. This joint laxity can be influenced by genetics.
8. Premature Birth: Babies born prematurely may have a higher risk of hip dysplasia because their hip joints may not have had sufficient time to develop in the womb.
9. Positioning: Incorrect positioning of the baby during the early postnatal period can contribute to hip dysplasia. For example, swaddling the legs too tightly or using incorrect baby carriers.

It's important to note that while these factors can increase the risk of hip dysplasia, not all individuals with these risk factors will develop the condition. Additionally, hip dysplasia can vary in severity, and some cases may be more mild and asymptomatic, while others are more severe and require treatment. Early detection and intervention are crucial for managing hip dysplasia.

How is Hip Dysplasia Diagnosed?

How hip dysplasia is diagnosed will in general depend upon how early it is picked up. Ideally it is picked up early in life as an infant as that will enable the best management and treatment. Below are some general ways in which hip dysplasia is diagnosed:

1. Physical Assessment: A doctor, physiotherapist or possibly a specialist nurse will perform a thorough physical examination of the patient. How this is done depends upon age. Commonly very soon after birth a hip movement test is performed to check the hips of new born babies. When older it will look at gait, strength, range of motion and symmetry at the hips. If the physiotherapist or doctor suspects hip dysplasia they will most likely order further investigations and imaging.
2. Imaging Tests: If hip dysplasia is suspected based on the physical examination, imaging tests may be ordered to confirm the diagnosis and evaluate the severity of the condition. Common imaging modalities include:
   • X-rays: X-rays provide detailed images of the bones and can reveal abnormalities in the hip joint, such as shallow acetabulum or dislocation of the femoral head.
   • Ultrasound: In infants younger than six months, ultrasound is often used to assess the hip joint's structure and detect dysplasia. It can visualize the cartilaginous structures of the hip joint and identify any abnormalities.
   • Magnetic Resonance Imaging (MRI): MRI may be used in older infants, children, and adults to obtain more detailed images of the hip joint, especially if further evaluation is needed or if other conditions are suspected.
3. Additional Diagnostic Procedures:
   • Arthrography: In some cases, a contrast dye may be injected into the hip joint before imaging tests to provide clearer visualization of the joint structures and detect any abnormalities.
   • Computed Tomography (CT) Scan: CT scans may be used in complex cases or to evaluate specific aspects of the hip joint in detail.

The key point to note about diagnosis of hip dysplasia is that the earlier the diagnosis is made the better the outcome is likely to be. Good management of hip dysplasia is essential in order to reduce the likelihood of complications such as osteoarthritis.

Treating Hip Dysplasia

The treatment options available for hip dysplasia depends mostly on the age of the individual and the severity of the symptoms that they are experiencing. Treatment options range from conservative measures including physiotherapy to surgery. Below is a general overview of the treatment options for hip dysplasia:

1. Infants (0-1 year):
   • Pavlik Harness: For infants diagnosed with mild to moderate hip dysplasia, a Pavlik harness may be prescribed. This specialized harness holds the baby's hips in a position that promotes proper alignment and development of the hip joint. The harness is worn full-time for several weeks to months, depending on the severity of the dysplasia and the response to treatment.
   • Closed Reduction and Spica Casting: In more severe cases of hip dysplasia or if the Pavlik harness is ineffective, a closed reduction may be performed. During this procedure, the doctor manually manipulates the hip joint into the correct position under anaesthesia. Following reduction, a spica cast is applied to maintain the hip's position during the healing process. The spica cast typically remains in place for several weeks to months.
2. Children and Adolescents
   • Surgical Interventions: Children and adolescents with significant hip dysplasia may require surgical interventions to correct structural abnormalities and improve hip joint stability. Surgical options include:
     • Open Reduction and Osteotomy: This procedure involves surgically repositioning the hip joint and correcting any deformities in the hip socket (acetabulum) or thigh bone (femur). Osteotomies may be performed to realign the bones and improve joint congruity.
     • Pelvic Osteotomy: Pelvic osteotomy involves reshaping the pelvic bones to improve the coverage of the femoral head within the acetabulum, thereby enhancing joint stability.
     • Femoral Osteotomy: Femoral osteotomy focuses on correcting deformities in the thigh bone to improve the alignment and function of the hip joint.

Physiotherapy after any of the above procedures for hip dysplasia will be a key part of recovery.

3. Adults
   • Non-Surgical Management: In adults usually the preferred option will be conservative and non-surgical management
     • Physiotherapy: Physio will be a key part of treating hip dysplasia for any adult diagnosed with hip dysplasia. This will aim to strengthen the muscles surrounding the hip joint, improve range of motion, and alleviate pain.
     • Activity Modification: Avoiding high-impact activities and reducing stress on the hip joint can help manage symptoms and prevent further deterioration.
     • Pain Management: Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to alleviate hip pain and discomfort.
   • Surgical Options:
     • Hip Arthroscopy: Arthroscopic surgery may be performed to address certain hip joint abnormalities, such as labral tears or loose bodies, and alleviate symptoms.
     • Hip Preservation Surgery: In cases where hip dysplasia is causing significant pain and functional impairment, hip preservation surgeries, such as periacetabular osteotomy (PAO) or hip resurfacing, may be considered to improve joint function and delay the need for hip replacement surgery.
     • Total Hip Replacement (THR): In severe cases of hip dysplasia associated with advanced arthritis, total hip replacement surgery may be necessary to replace the damaged hip joint with an artificial implant and relieve pain.

The key point to note about treatment options for hip dysplasia is that early diagnosis is the key as this significantly reduces the likelihood of needing aggressive surgeries such as a hip replacement in later life.

How Can ThreeSpires Physiotherapy Help with My Hip Dysplasia?

Physiotherapy can be extremely useful if you have been diagnosed with hip dysplasia or suspect that you may have it and one of our physiotherapists will be able to help with:

1. Assessment & Diagnosis of Hip Dysplasia: this is a vital part of dealing with your hip dysplasia and the sooner you have an assessment the sooner you will know what you are dealing with. Our physiotherapists will be able to comprehensively assess your hip, make a diagnosis of the underlying cause of your pain and refer on for imaging if needed.
2. Management Plan: once a diagnosis of dysplasia has been made it is vital that you get a clear and comprehensive plan to begin managing your condition.
3. Exercises for Hip Dysplasia: your physiotherapist will be able to determine which are the most appropriate exercises for your hip and will be able to prescribe the optimum number and frequency to promote recovery.
4. Hands on Treatment: In conjunction with load management and exercises your physio will be able to use soft tissue and hands on techniques to treat any areas that have become overloaded and tight such as your back.

Okay, I hope that you have found this article about hip dysplasia helpful and it is part of a series of articles that we are completing about each of the specific causes of hip pain. Should you or anyone you know have hip dysplasia please get in touch and one of our physios would be happy to help. Just to remind you we are a home visit physiotherapy service and our physios are mobile and will come out to you at home.