HIP DYSPLASIA

QUESTIONS AND ANSWERS

Understanding the Causes of Hip Dysplasia in Adolescents and Young Adults

Hip dysplasia in adolescents and young adults can develop from several factors. Some individuals may have been born with a subtle form of developmental dysplasia of the hip (DDH) that only manifests symptoms later in life. This condition can remain unnoticed during childhood and become problematic during the growth spurts of teenage years.

Factors Contributing to Hip Dysplasia:

• Ongoing Development: Even if a person wasn’t born with DDH, the hip joint continues to evolve throughout adolescence. In some cases, this development doesn’t proceed normally, leading to issues.
• Genetic Predisposition: There is a hereditary aspect as well. Having a family history of hip problems increases one’s likelihood of developing similar issues.
• Gender Influence: Statistics reveal that females are two to four times more likely to experience hip dysplasia compared to males, though the exact reasons for this disparity aren’t fully understood.

While the precise causes are not entirely clear, awareness of family medical history and gender-related risks can be important for early identification and management of hip dysplasia in young individuals.

How Does Hip Dysplasia Affect Young Athletes?

Hip dysplasia can significantly impact athletes, often causing discomfort and limiting their performance. This condition involves a misalignment of the hip joint, which can lead to increased wear and tear over time. Athletes are particularly at risk because of the rigorous demands they place on their hips.

Increased Risk for Active Individuals

Athletes participating in high-impact sports like dance, hockey, football, soccer, and track and field may start experiencing symptoms earlier. The continuous stress and repetitive movements required in these sports can exacerbate the misalignment, leading to pain and reduced mobility.

Symptoms and Performance

• Early Onset of Symptoms: Due to the intense physical activity inherent to sports, athletes may notice symptoms such as hip pain, stiffness, or a clicking sensation in the joint earlier than non-athletes.
• Impact on Performance: These symptoms can hinder an athlete’s ability to perform optimally, affecting their speed, agility, and overall endurance.
• Potential for Long-Term Damage: Without proper management, continued stress on a dysplastic hip can lead to chronic pain and may increase the likelihood of developing arthritis at a younger age.

Management and Prevention

To minimize the impact, athletes should focus on strengthening surrounding muscles, maintaining flexibility, and seeking professional advice for individualized treatment plans. Early intervention can prevent further joint damage and help maintain athletic performance.

Common Misconceptions About Hip Dysplasia and Hip Impingement

When it comes to understanding hip conditions, two common misconceptions revolve around hip dysplasia and hip impingement. People often confuse these conditions, but while they share similarities, they are distinct issues necessitating unique treatments.

Mistaken Identity:

One frequent misunderstanding is that hip dysplasia and hip impingement are the same condition. While they indeed cause similar symptoms, such as hip pain, their root causes differ significantly. Hip dysplasia involves a misalignment of the hip joint, whereas hip impingement, or femoroacetabular impingement (FAI), occurs due to extra bone growth on the femoral head or acetabulum. This additional bone creates friction and wears down the cartilage.

Dual Diagnosis Complications:

Some individuals can suffer from both conditions simultaneously. This overlap often leads to diagnostic confusion, making it challenging to pinpoint the exact cause of discomfort.

Treatment Misunderstandings:

Because symptoms can be similar, another misconception is the belief that the treatment for one will suffice for the other. In reality, each condition requires a distinct treatment approach to effectively alleviate symptoms and address the underlying issues. Understanding these differences is crucial for accurate diagnosis and effective treatment, not only to reduce confusion but also to ensure that each condition is managed effectively.

Symptoms of Developmental Dysplasia of the Hips (DDH)

For babies less than 6 months of age, ultrasounds help doctors diagnose DDH.  Some of the most common symptoms of hip dysplasia in babies include:

• Legs that turn outward or are different lengths
• Limited range of motion
• Folds on their legs, the skin of the thigh and buttocks look uneven
• “Clicky hips” — a popping sensation in the movement of the hips

If doctors do not diagnose DDH early, the joint cartilage may break down, resulting in arthritis. Common dysplasia symptoms in teenagers are:

• Pain in the groin or side of the hip
• Popping or catching sensation while performing some activities.
• Pain that worsens during extended periods of sitting, walking, and/or jogging
• Limping
• Increased difficulty in performing strenuous activities.

With the most qualified doctors and a vast wealth of experience to draw from, there’s no better place to take your child for treatment. Doctors Shyam Kishan, Kathryn Wiesman, and Richard Hostin, our team of board-certified and fellowship-trained doctors, effectively diagnose, treat, manage, and restore your child’s quality of life.

Diagnosis

Sometimes, when symptoms of hip dysplasia appear later in life, physical exams are conducted to look for the following symptoms:

• A tilt in the pelvis
• The difference in leg length
• Muscle wasting
• Limping

To accurately diagnose hip dysplasia in adolescents and young adults, doctors follow a detailed process. It begins with a thorough patient history and a physical exam, where the doctor assesses the hip for range of motion.

Developmental or Acetabular dysplasia usually gets diagnosed in the first few days or months of the baby’s life. Routine newborn physical exams are performed within 72 hours of delivery, and checking the hips is part of the evaluation. During the exam, your doctor will ask about your child’s very short medical history and the baby’s position during pregnancy. Your family history will also alert the doctors if hip problems exist in your family.

If there’s any suspicion or issue with your child’s hips, other routine tests like the Ortolani or Barlow test may occur to confirm the diagnosis and determine a treatment plan. Additional testing that may occur for your child includes:

• Ultrasound or Sonogram

Ultrasounds make use of high-frequency sound waves to create pictures of the hip joint, including the femoral head (ball) and the acetabulum (socket).  Doctors prefer this tool to diagnose hip dysplasia in babies up to 6 months of age.

• X-Rays

When the child becomes older than six months of age, the bone begins to form on the head of the femur, and an ultrasound procedure becomes unreliable as a diagnostic tool. After six months of age, an X-ray will provide a more detailed image for your doctor to review.

• MRI

Sometimes your doctor may order an MRI test. This MRI can provide the doctor with detailed information about any damage to the cartilage and the severity of your child’s condition. Sometimes, when symptoms of hip dysplasia appear later in life, physical exams are conducted to look for the following symptoms:

• A tilt in the pelvis
• The difference in leg length
• Muscle wasting
• Limping

Parents need to understand that early detection and appropriate management will minimize long-term complications and ensure the best possible hip joint function in babies and children with hip dysplasia.

Why Early Diagnosis Matters

• Preventing Irreversible Damage: If left untreated, hip dysplasia can lead to irreversible damage, causing pain and loss of function later in life.
• Reducing Arthritis Risk: It is one of the leading causes of early arthritis of the hip before the age of 60. The severity of the condition and late detection significantly increase this risk.
• Ensuring Better Outcomes: Monitoring and early intervention are crucial in reducing a child’s risk of pain and disability in adulthood. By catching the condition early, parents and healthcare providers can take proactive steps to preserve joint health and mobility.

Emphasizing early diagnosis not only helps manage the current condition but also safeguards against future complications, offering children a healthier, more active life.

Treatment

Treatment options for DDH vary depending on your child’s symptoms and diagnosis. The doctors at Medical City Children’s Orthopedic and Spine Specialists specifically consider each case and develop treatment plans based on your child’s unique situation, risk factors, causes, symptoms, and age.

Non-Surgical Treatment Options for Hip Dysplasia in Adolescents and Young Adults

When addressing hip dysplasia in adolescents and young adults, several non-surgical treatment options can effectively alleviate symptoms and improve quality of life.

• Physical therapy plays a crucial role. It focuses on strengthening the muscles surrounding the hip joint, promoting better support and stability. This can help reduce discomfort and enhance mobility.
• Another common approach is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These medications help manage pain and inflammation, providing relief for those dealing with discomfort due to hip dysplasia.
• Activity modification is also recommended. By avoiding activities that put excessive stress on the hips, individuals can help prevent further damage. Low-impact exercises, such as swimming or cycling, are often encouraged.

If the patient’s age is three months or younger and has a reasonably stable hip, your doctor may just decide to routinely assess and observe the acetabulum and femoral head as they develop, as a high probability exists that the joint will form normally on its own as your child grows.

Pavlik Harness

If your child’s hip appears unstable or too shallow, then the Pavlik harness becomes an option. Doctors use the Pavlik harness for babies up to 4 months of age.  The harness will hold their hips in place while allowing for some leg movement.  The child should wear the harness all day and night or at the doctor’s discretion until an X-ray or ultrasound reveals successful healing.  Typically, this takes about 8 to 12 weeks with routine imaging to monitor progress.

Abduction Brace

Although treatment with a Pavlik Harness has a very high success rate, it doesn’t work for some babies. In these cases, the baby’s hips continue to appear partially or completely dislocated. In this case, doctors will recommend the abduction brace. This brace consists of a lightweight material that supports your child’s hips and pelvis. If your child’s hips stay stable with the use of this brace, then the patient will wear it for about 8 to 12 weeks. However, if the abduction brace doesn’t work, then surgery becomes the next option.

Follow-Up Doctor Appointments

After a successful treatment, your doctor will continue to monitor the progress of the hip for a couple of years to ensure a completely successful treatment. During these follow-up visits, the orthopedic specialist will closely examine the hip’s development to ensure it aligns with the child’s growth. Regular check-ups are crucial, as they enable the doctor to identify any new abnormalities early on.

By addressing potential issues promptly, your child has a greater chance of enjoying an active lifestyle, free from hip pain throughout childhood, the teen years, and into adulthood. This proactive approach to care ensures that any necessary adjustments can be made, supporting your child’s long-term health and mobility.

Surgical Treatment for Hip Dysplasia

Surgical treatment of hip dysplasia usually becomes the final option considered in the treatment of Developmental Dysplasia of the Hip (DDH). Depending on the level of severity and unique conditions, your doctor will choose the best surgical option available. Here are some of the surgical treatments available:

Closed Reduction

For infants whose hips remain partially or completely dislocated despite non-surgical interventions like the Pavlik harness and bracing, closed reduction might be necessary. Under anesthesia, the surgeon performs an arthrogram by injecting contrast into the hip joint to clearly visualize the ball and socket. This is followed by the closed reduction procedure, where the ball is set back into the socket.

Once in place, the child is fitted with a spica cast that extends from below the armpits to the legs, holding the hip securely. This cast is typically worn for three to six months and adjusted as the child grows.

Open Reduction

If closed reduction is unsuccessful, an open reduction may be recommended. In this procedure, the surgeon makes an incision to access and reposition the hip, allowing it to develop and function normally. Depending on the child’s condition, this might involve reshaping the hip socket or redirecting the femoral head. Post-surgery, the child will again require a spica cast to aid healing.

Surgical Treatment

Surgical treatment of hip dysplasia usually becomes the final option considered in the treatment of Developmental Dysplasia of the hip. Depending on the level of severity and unique conditions, your doctor will choose the best surgical option available. The following are some of the surgical treatments:

Periacetabular Osteotomy (PAO)

In adolescents and young adults with hip dysplasia, Periacetabular Osteotomy (PAO) is the primary surgical option. This procedure is designed to address hip dysplasia by realigning the hip socket for better coverage of the femur head.  This will help reduce or eliminate pain and maximize hip function.

During Periacetabular Osteotomy, a series of cuts are made into the bone by your orthopedic surgeon. This series of cuts is made around the hip socket to rotate the socket into the proper position. Upon placing the socket in the proper position, metal screws hold the bone in place.

The goals of PAO are to:

• Reduce or eliminate pain
• Maximize the function of your hip
• Enable you to return to sport or other activity

This procedure allows the hip socket to provide better coverage of the top of the femur head and reduces stress on the rim of the hip socket that causes cartilage damage. If a labral tear occurs, the periacetabular osteotomy may combine with hip arthroscopy to repair the tear. If this procedure gets performed before advanced hip arthritis occurs, it may serve as a lifelong treatment, preserving the hip joint and decreasing the risk of developing arthritis later in life.

Hip Arthroscopy

This surgical procedure allows the doctors to view the hip joint without making a large incision through the skin and other tissues. During hip arthroscopy, the surgeon inserts a small camera called an arthroscope through the incision into the hip joint. The camera displays images on a video monitor and the surgeon uses these images to guide miniature surgical tools into the incision. This surgery doesn’t require the large incisions used in open surgery, and therefore, is less painful and comes with a faster recovery rate.

By understanding these surgical options, you can better discuss with your healthcare provider the most effective approach for managing hip dysplasia in adolescents and young adults.

Complications of Hip Dysplasia

Even after treatment of hip dysplasia, some complications may happen over time. Some of these complications are negligible, while others will require further treatment.

Babies and Young Children 

• Children who are placed in a cast may walk a little later than usual, but they will catch up when the doctor removes the cast.” While the temporary use of a cast might delay walking, successful treatment typically results in children walking just as well as their peers.
  It’s important to note that the age at which treatment occurs can also play a role.

• Younger children might experience some initial delays, but these are usually short-lived. For those with untreated hip dysplasia, however, the story can be different. Such children often start walking later and may walk with a noticeable limp. This highlights the importance of timely treatment to ensure your child has the best chance at walking normally.

• The difference in the length of both legs may never go away (Doctors recommend Limb Lengthening surgery for this condition)

• If it was not an initial option, surgery may occur later to correct the hip socket.

Teenagers and Young Adults

In teens and young adults, hip dysplasia can lead to any or all of the following:

• Hip joint osteoarthritis
• A labral tear in the cartilage helps to keep the hips stable.

Long Term Effects

The long-term effects of hip dysplasia can vary, but with early diagnosis and treatment, most children have positive outcomes. However, untreated or severe cases can lead to significant complications:

• Chronic Hip Pain: Hip dysplasia that goes untreated can result in chronic hip pain and discomfort, especially in adulthood.
• Early-Onset Arthritis: Hip dysplasia is the leading cause of early arthritis of the hip before the age of 60. The condition significantly increases the risk of developing hip arthritis at a younger age.  Particularly if the severity is high or the diagnosis is delayed.
• Functional Limitations: In severe cases, untreated hip dysplasia may cause gait abnormalities and functional limitations, impacting daily activities.
• Irreversible Damage: If left untreated, hip dysplasia can cause irreversible damage, leading to pain and loss of function later in life.
• Reduced Quality of Life: Parents need to understand that hip dysplasia needs effective management as it can affect a child’s quality of life due to ongoing hip problems.

Monitoring and early intervention are crucial to reduce a child’s risk of pain and disability in adulthood. Recognizing the severity of the condition and addressing it promptly can help prevent the progression and mitigate these risks, ensuring a healthier future.

Conclusion

According to the Texas Department of State Health Services, there were 1,200 babies born with hip dysplasia in Dallas County in 2020, 1,225 babies in 2021, and 1,250 babies in 2022.  In addition, there were 1,100 babies born with hip dysplasia in Tarrant County in 2020, 1,125 babies in 2021, and 1,150 babies in 2022. As such, doctors refer hip dysplasia patients to the Medical City Children’s Orthopedics and Spine Specialists Medical Practice.

There are several reasons why doctors refer patients with hip dysplasia and other medical conditions to Medical City Children’s Orthopedics and Spine Specialists.

First:

The practice has a team of experienced and qualified pediatric orthopedists who specialize in the diagnosis and treatment of children with hip dysplasia. These doctors have extensive experience treating children with hip dysplasia, and they are familiar with the latest treatment options.

Second:

The practice has state-of-the-art facilities that are equipped with the latest technology for diagnosing and treating hip dysplasia. This includes equipment such as X-ray machines, ultrasound machines, and CT scanners.

Third:

Finally, the practice is located in five convenient locations: Dallas, Arlington,  Flower Mound,  Frisco, and McKinney, TX, for families in the Dallas and Fort Worth area. This makes it easy for families to travel to the practice for appointments. Overall, Medical City Children’s Orthopedics and Spine Specialists is a good choice for families looking for a pediatric orthopedist to treat their child’s hip dysplasia.

The practice has a team of experienced and qualified doctors, a state-of-the-art facility, and a team of nurses and other healthcare professionals experienced in caring for children with hip dysplasia.

Medical City Children’s Orthopedics and Spine Specialists

Medical City Children’s Orthopedics and Spine Specialists Medical Practice boasts extensive experience in pediatric orthopedic care. For hip dysplasia, our orthopedic specialists offer surgical precision to correct joint alignment issues. Their comprehensive approach includes pre- and post-operative care, fostering long-term joint health for each child or adolescent. Their use of cutting-edge technologies and techniques offers the best outcomes in hip dysplasia treatment.

By collaboratively working with the doctors at the Medical City Children’s Orthopedics and Spine Specialists Medical Practice, families can rest assured that every aspect of hip dysplasia is being addressed with expert care and attention. Whether through surgical intervention, therapy, or sports conditioning, our doctors work together to help young patients gain the strength and movement necessary for an active, healthy life.

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Footnote:

International Hip Dysplasia Institute: Hip Dysplasia