Hip Dysplasia - Symptoms and Causes | GetWellGo

Hip Dysplasia

Hip Dysplasia by definition refers to a developmental abnormality of a joint and in particular hip dysplasia is characterized by an improperly formed hip joint leading to instability, pain and occasional arthritic changes. It commonly affects the joint where the ball (femoral head) nested in the socket (acetabulum) but is not smoothly and firmly inserted into the cup – like structure.

Hip dysplasia is of two broad categories:

• Developmental Dysplasia of the Hip (DDH): This is one of the congenital diseases that affect the incidence of the hip joint. More so, it is often presents in the children below the age of five years.
• Acquired Hip Dysplasia: This type occurs progressively due to factors such as injury, overuse, or in some instances due to aging thus affecting the adults.

Hip Dysplasia Symptoms

• Hip pain, especially in the groin or outer thigh
• Limited range of motion
• Instability in the hip or a sensation of the hip collapsing.
• Some of the symptoms include; difficulty in walking or limping.
• A sound that can be described as a click or a pop in the hip area is abnormal and should be addressed.

Hip Dysplasia Causes

There are several ways by which hip dysplasia can be triggered hence it may be genetic, environmental or both. Here it is some cases and factors, they are as follows:

Genetic Factors

• Risk Factor 1: Hip dysplasia also has a genetic predispose as it is known to run in the families; thus if one is a victim, the chances are high that generations in their family also experienced the same.
• Genetic Factors: Some hip malformations can be hereditary and therefore contributes to the formation of dysplasia.

Developmental Factors (DDH)

• Jerks while Pregnant: The posture of the baby in the womb seems to have some role in the development of the hip joint of a new-born baby. Lack of room in the uterus, particularly when the baby presents in the breech position, which is when the baby’s feet or bottom is facing down in the womb, increases the risk of baby having hip dysplasia.
• It is characterized as low amniotic fluid levels in pregnant women that limit fetal motion and impede the growth of joints.
• Swaddling: The tight bundling of a baby or keeping baby’s legs straight might hinder natural crossing of the legs and can lead to DDH.

Trauma or Injury

• Damage to the Joint: Any kind of direct injury to the hip joint such as fracture-dislocation will adversely affect the hip joint and may lead to dysplasia or exacerbation of dysplasia.
• Stress or Trauma: Repeated stress or trauma, such as the one experienced by athletes or those people who perform high impact activities regularly can also be a cause of acquired hip dysplasia particularly in the adulthood.

Environmental Factors

• Gender: Hip dysplasia is common in females than males; this may be cause by differences in structure of the pelvic region.
• Firstborn children: Firstborn children are also more vulnerable; this could be attributed to the following reasons; that the pelvic space of the mother is narrow during childbirth.
• Birth Weight: Hip dysplasia is also common among babies with low birth weight or those born preterm.

Other Medical Conditions

• Some diseases, for example, Ehlers-Danlos syndrome or Down syndrome that involve connective tissues pose the chances of joint instability including the hip dysplasia.
• Some of the conditions that are associated with hip dysplasia include cerebral palsy, spina bifida or any other diseases that affect muscles as well as bone growth.

Acquired Hip Dysplasia in Adults

• Wear and Tear (Osteoarthritis): With age, the cartilage in Hip joint may steadily wear out thus developing or worsening of Hip Dysplasia results into pain and limited movements.

• Obesity: Too much weight also creates on the hip joint brings possibility of development of dysplasia or increases the instability of the joint in case it already been affected.

• Pre-existing Injuries: Any past hip injuries or hip replacement surgeries may have shifted the position/shape or form of the hip joint and may well lead to dysplasia.

Hip Dysplasia Treatment

The treatment of hip dysplasia depends with the degree of developing hip dysplasia, age, whether the hip dysplasia is congenital or not. Thus, some of the treatment methods include non-surgical ones and various surgical ones as well.

Non-Surgical Treatment

These are initial treatments that are usually given to patients who have trivial or first attack episodes or relatively young patients.

• Physical Therapy
• Medications
• Bracing or Splinting
• Lifestyle Modifications
• Weight Management

Surgical Treatment

Surgery might be advisable in extreme cases or where other treatments cannot help to treat the situation effectively.

• Osteotomy
• Hip Arthroscopy
• Total Hip Replacement
• Periacetabular Osteotomy

Post-Surgical Rehabilitation

Rehabilitation is vital in the later stages to help the individual achieve functional recovery of the hip joint. This typically includes:

• Physical Therapy
• Gradual Weight-Bearing
• Pain Management

Long-Term Management

• Lifestyle Adjustments
• Monitoring

Hip Dysplasia in Adults

Adult hip dysplasia usually develops from hip dysplasia, which is more common in infancy or childhood, but left untreated or undiagnosed. In the long-run it would result in difficulties within the hip joint, problems like pain, instability, and even chances of developing osteoarthritis of the joint. Although hip dysplasia affects children more often, the disease may not manifest or progress in the adult population for many years.

Causes of Hip Dysplasia in Adults

The causes of hip dysplasia in adults are as follows:

• Health consequences of untreated developmental dysplasia in childhood: It is possible to have mild developmental dysplasia in childhood and never realize that you have it until you start feeling pain or experiencing some other problems in adulthood.
• Acquired hip dysplasia: This occurs where an injury takes place, or constant stressing of the hip joint alters the constitution of the joint and instability arises.
• Arthritis: The condition can progress to affect degenerative arthritis and afterward may just be painful and worsens joint degeneration.
• Genetics and Family History: There are certain hereditary factors which become influential in causing the problem of hip dysplasia in adults.

Hip Dysplasia in Infants

Developmental dysplasia of hip or DDH refers to a condition in which the hip joint is not developed as it should in infants. The head of the thighbone is not firmly in place in the socket of the pelvis known as acetabulum. It can be partially or fully displaced or even totally displaced.

Hip Dysplasia Diagnosis

Newborn Physical Examination

• Barlow Test: Examiner is performed to know whether the hip joint can be dislocated or not.
• Ortolani Test: It is used to see whether a dislocated hip can be relocated or moved back into their proper position or not.
• Given within 72hr of birth and then at every subsequent visit.

Ultrasound Imaging

• Sought for babies less than six months of age before the hip bones begin to calcify.
• Enables assessment and portrayal of cartilage and joint on real-time movements.

X-ray

• A different type is applied after six months of age when the child’s bones can be detected on x-rays.
• Shows the position of the femoral head and development of the socket.

Risk-Based Screening

• Some of the patients might undergo imaging early even though the physical examination is normal due to certain risk factors that they might possess such as breech birth or family history.

Hip Dysplasia Surgery

Periacetabular Osteotomy (PAO)

• Who it’s for: Young people that are most of the time still in their 30s and have not had surgeries, arthroscopy, or have severe osteoarthritis with bad cartilage.
• What it does: Shifts the acetabulum away from the femoral head to be more adequately positioned to cover it.
• Improve general health and quality of life and, in the process, prevent joint replacement surgery for as long as possible.

Recovery:

• Hospital stay: ~3–5 days
• Weight-bearing: Limited for 6–8 weeks
• Full recovery: 6–12 months with physical therapy

Femoral Osteotomy

• For whom it is suitable: For patients with a deformity of the femur, the main cause of which is an improper alignment.
• What it does: Osteotomy that is, cutting and reshaping of the femur in order to make it fit into the socket.
• This device may sometimes be done in conjunction with PAO in order to increase the overall range of correction achieved.

Hip Arthroscopy

• This is suitable for: Weaker hip cases that have impingement, labral tear or cartilage problem.

What it does:

• Repairs soft tissues (labrum, cartilage)
• Reshapes bone to prevent impingement
• Minimally invasive, often outpatient.
• Recovery: 4–6 weeks for basic mobility, 3–6 months for full return to sports.

Open Reduction & Spica Casting (Pediatrics)

• For whom: Infants or toddlers when the solution of regular braces is not efficient.
• What it does: the position is directly adjusted by manoeuvring the femoral head into position and then applying spica cast.
• It may be done alone at times or associated with the pelvic or femoral osteotomy in case of anatomical deformities.

Total Hip Replacement (THR)

• It is for: Patients with a severe degree of dysplasia and joint diseases with signs of arthritis.
• What it does: It includes the removal of the socket and the femoral head and replacing them with artificial parts.

Considerations:

• May need special implants or techniques owing to the fact that the bone structure of the knee is not normal.
• Consequently, the prosthetic durability ranges from 15 to 25 plus years of service because of the users’ physical activities.

Hip Dysplasia Risk Factors

Hip dysplasia complications: In Infants and Children

• Family History
• Female Sex
• Breech Presentation
• First-Born Baby
• Low Amniotic Fluid
• Tight Swaddling After Birth
• Torticollis
• Clubfoot
• Spina bifida

In Teens and Adults

• Undiagnosed/Untreated DDH in Childhood
• Female Hormonal Effects
• Joint Hypermobility
• High-Impact Sports (with pre-existing dysplasia)