Hip Dysplasia in Adolescents

What is hip dysplasia?

Hip dysplasia occurs when the hip socket (acetabulum) doesn't develop properly and is too shallow to cover the head of the thigh bone (femoral head) completely. Many adolescents and young adults with the condition were born with developmental dysplasia of the hip (DDH). In others, previously healthy hips did not develop properly as their bones and bodies grew.

Meet Alana and Nicole.

A year and a half after hip surgery, Nicole still questioned her physical capabilities. That changed when she met Alana, another dancer who’d had the same surgery. This chance meeting, and the friendship that grew out of it, became a turning point in both dancers’ healing.

 

Read their story

The condition ranges from a mild abnormality of the hip socket to a complete dislocation of the hip. As children become more active and demand more of their legs, the ill-fitting hip joint becomes unstable. The instability damages cartilage inside the joint that becomes increasingly painful over time.

It is important not to ignore hip pain. Hip dysplasia is a treatable condition but early diagnosis and treatment are critical to preventing irreversible damage.

What are the symptoms of hip dysplasia in adolescents and young adults?

Teens or young adults may develop a limp or have hip pain in the front of the hip or groin. For others, the first sign is knee pain. You might hear a clicking sound in your hip. As the damage progresses, you may find it more and more painful to participate in sports and other activities. Without treatment, the pain will continue to become worse.

What causes hip dysplasia in adolescents and young adults?

Some teens and young adults are born with mild DDH that becomes symptomatic as they grow. However, the hip joint continues to develop throughout the teen years and sometimes does not develop properly, even if you were not born with DDH. Doctors are not sure why this happens but they do know that the condition affects girls two to four times as often as boys. People with a close relative with hip problems are also at higher risk.

How is hip dysplasia diagnosed in adolescents and young adults?

Doctors typically use variety of tests to determine if dysplasia is the source of hip pain in adolescents and young adults.

The first step is a thorough patient history and physical exam. The doctor will check your hip for range of motion. They may order imaging studies such as an x-rayMRI or CT scan to confirm the diagnosis. Ultrasound-guided diagnostic injection can help your doctor determine the location of your hip pain with greater precision.

How is hip dysplasia treated in adolescents and young adults?

The goal of treatment is to restore normal hip function and eliminate pain. Your treatment will depend on the severity of your condition.

Non-surgical treatment options for adolescents and young adults

Mild to moderate cases of hip dysplasia are often treated with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs). If you continue to be in pain after these treatments, your physician may suggest surgery.

Surgical options for adolescents and young adults

Periacetabular osteotomy (PAO) is the main surgical treatment for adolescents and young adults with hip dysplasia. PAO may serve as a lifelong treatment if performed before serious damage occurs within the joint.

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
 

During a PAO, the surgeon makes a series of cuts in the hip bone so they can rotate the socket into proper position. They then insert metal screws to hold the bone in place. These screws are usually removed in an outpatient procedure four to 12 months after surgery.

Sometimes, hip dysplasia causes the cartilage surrounding the hip joint to tear, a condition known as labral tear. If this is the case, your surgeon may also perform a hip arthroscopy on the same day as the PAO. In this minimally invasive procedure, the surgeon uses miniature instruments to repair the torn cartilage inside the joint.

If you have severe hip dysplasia and significant damage inside the joint, you may need a full hip replacement. You and your physician may decide to delay the procedure until you have finished growing. Non-surgical treatments such as steroid injections, anti-inflammatory medication, and physical therapy can help control your pain until you are ready for the surgery.

Recovery and long-term outlook

Physical therapy usually begins the day after surgery and starts with range-of-motion exercises. A physical therapist will assist you with walking as you support your weight on parallel bars and then with crutches.

You will be discharged with a home exercise program. Following your physical therapist’s advice will help you rebuild strength in your leg and play an important role in your recovery. You should be prepared for your strength to return gradually after surgery. Most patients need to use crutches for three months after PAO, followed by physical therapy after they no longer need crutches.

After your hip has healed, your clinical team will work with you to determine your best options for returning to sports and other physical activities. You may need to avoid certain high-impact sports that could increase your risk of future injury. No matter what, it’s important to return to activity carefully and avoid overtraining.