I have been diagnosed with hip dysplasia as a teenager, however have I always had hip dysplasia?

In many cases adolescent hip dysplasia is a progression of paediatric hip dysplasia, and patients will have had some failure of hip formation as a younger child. In some cases patient may have had treatment as a child for hip dysplasia and may have had a relatively normal hip, however over time the hip joint formation regresses, and this can result in poor socket formation as an adolescent.

How long is recovery after hip dysplasia surgery?

This depends on the nature of the surgery which is undertaken. After a periacetabular osteotomy, most patients are back to playing sport and activities at approximately 3-4 months.

I get clicking and catching in my groin, is this a sign of hip dysplasia?

Clicking and catching in the groin can be a sign of hip dysplasia, and instability of the hips lies in and out of its socket. If you have these symptoms would highly recommend that you are evaluated by a specialist orthopaedic surgeon.

I have hip dysplasia, what is the risk of developing hip arthritis?

This is a very difficult question to answer without a thorough evaluation of your x-rays and an assessment of your condition. The risk of developing arthritis is directly related to the amount of bony coverage of the ball of the femur.

What happens if avascular necrosis is left untreated?

When avascular necrosis is left untreated, the disease will progress. The bone may develop a crack, in which the bone collapses. Should this occur at the end of the bone, the surface of the joint will be irregular, which can cause arthritic pain and loss of function to the affected joint.

Does exercise help avascular necrosis?

There is no evidence exercise helps avascular necrosis, and weight bearing on a hip with avascular necrosis can contribute to collapse of the joint and the development of arthritis. It is essential that your hip is evaluated by a hip specialist to determine the correct physical regime for you.

Will avascular necrosis spread to other bones in the body?

No, avascular necrosis cannot spread to other bones in the body. In the absence of other conditions, AVN will stay in the same body part. However, avascular necrosis can occur in other parts of the body, for example if it affects one hip, there is between 10-40% chance it can affect the other hip.

How common is femoroacetabular impingement?

FAI is most common in healthy, active adults and athletes between the ages of 25-50 years. In older patients, it is also frequently accompanied with osteoarthritis.

Does stretching help hip impingement?

Addressing internal rotation to combat symptoms can sometimes provide relief, however if you're too aggressive and stretch too high up into hip flexion it can actually increase hip pain. For this reason, it is important to seek professional help when treating FAI.

Is surgery required for hip impingement?

Typically, non-surgical methods for therapeutic injections are used to treat hip impingement before surgery. If pain persists, we may recommend surgery to reshape the bones in the hip joints.

What happens if a labral tear goes untreated?

If left untreated, a labral tear can become an irritant to the hip joint which can increase friction and speed the presence of osteoarthritis in your hip. If the tear gets worse, it can become a tissue flap that can cause severe pain when moving your hip. Treatment may be recommended and can help minimise pain.

What aggravates a hip labral tear?

Labral tears are most commonly caused by structural abnormalities in the hip, and they can additionally be caused by repetitive injuries from lunging, squats, kicking, sports and extremes of range of motion. Cycling can bean aggravatingactivity as hip flexion combined with other movements can aggravate your pain. You may also wishto avoidactivities such as football, soccer, gym, basketball and ballet as they can irritate the tear and cause sharp pain in the groin or hip. Treatment of labral tears may provide relief allowing you to return to some activities you enjoyed.

What does a labral tear feel like?

For many patients, a torn labrum may show no symptoms, making diagnosis difficult. For others, pain in the hip joint, groin or buttocks can be a sign of a torn labrum, sometimes experienced alongside an audible clicking sound in the joint when engaging in high-intensity activity. Pain levels usually correlate with activity, subsiding with rest.

Do I need surgery for a torn labrum?

Surgery may be required to correct a hip labral tear, as often a torn labrum is a symptom of a deeper structural issue with the hip. In this case, simply correcting the tear may not provide effective relief to the patient. In cases where the labral tear has no underlying cause, some conservative treatment methods such as NSAID drugs and targeted physical therapy can provide relief. Surgical treatment often takes the form of minimally-invasive hip arthroscopy.

How is a hip labral tear diagnosed?

Labral tears are normally diagnosed by a combination of physical examination and assessment of the hip joint, and confirmed by an MRI.

What is the difference between hip dysplasia and hip arthritis?

While symptoms may be similar, Hip dysplasia is a developmental disorder largely influenced by genetics. Hip arthritis on the other hand can be caused by a range of factors including weight, joint injury or increasing age.

What is the difference between hip arthritis and a labral tear?

Labral tears are typically caused by trauma, arthritis, femoroacetabular impingement or acetabular dysplasia, while the most common cause of hip arthritis is old age. Labral tears are also more common in athletes, however people with labral tears in their hip are also more likely to develop hip arthritis.

DDH - Developmental Dislocation (Dysplasia) / Congenital Hip Dislocation

Home > Condition & Treatment Map > Hip & Pelvis Conditions & Treatments > DDH - Developmental Dislocation (Dysplasia) / Congenital Hip Dislocation

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Overview

The hip is a "ball-and-socket" joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvic bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may easily dislocate. Although DDH is most often present at birth, it may also develop during a child's life.

Condition

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes, the ligaments that help to hold the joint in place are stretched. The degree of hip looseness, or instability, varies among children with DDH.

Dislocated: In the most severe cases of DDH, the head of the femur is completely out of the socket.

Dislocatable: In these cases, the head of the femur lies within the acetabulum, but can easily be pushed out of the socket during a physical examination.

Subluxatable:. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

The Left hip is normal with the femoral head in the socket. The right hip has DDH where the hip head is out of the socket.

Causes

DDH tends to run in families. It is also predominant in:

Girls
First-born children
Babies born in the breech position (especially with feet up by the shoulders). The American Academy of Pediatrics now recommends ultrasound DDH screening of all female breech babies.
Family history of DDH (parents or siblings)
Oligohydraminos (low levels of amniotic fluid)

Symptoms

Some babies born with a dislocated hip will show no signs.

Contact your GP or Paediatrician if your baby has:

Legs of different lengths
Uneven skin folds on the thigh
Less mobility or flexibility on one side
Limping, toe walking, or a waddling, duck-like gait

Treatment

When DDH is detected at birth, it can usually be corrected with the use of a harness or brace. If the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated, with less predictable results.

Treatment methods depend on a child's age:

Newborns

The baby is placed in a soft positioning brace, for 1 to 2 months to keep the thighbone in the socket. This special brace is designed to hold the hip in the proper position while allowing free movement of the legs and easy nappy changes. The brace helps tighten the ligaments around the hip joint and promotes normal hip socket formation. Parents play an essential role in ensuring the harness is effective.

1 month to 6 months

Similar to newborn treatment, a baby's thighbone is repositioned in the socket using a brace or similar device. This method is usually successful, even with hips that are initially dislocated. How long the baby will require the harness varies. It is usually worn full-time for at least 6 weeks, and then part-time for an additional 6 weeks.

If the hip will not stay in position using a harness, our specialists may try an abduction brace made of firmer material that will keep your baby's legs in position.

In some cases, a closed reduction procedure is required. This involves gently move your baby's thighbone into proper position, and then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anaesthesia.

6 months to 2 years

Older babies are also treated with closed reduction and spica casting. In some cases, skin traction is used for a few weeks prior to repositioning the thighbone. Skin traction puts a gentle force on the skin and stretches the soft tissues around the hip for the change in bone positioning. In some cases the femur may need be openly placed back into the socket. In this procedure, an incision is made at the baby's hip that allows the surgeon to clearly see the bones and soft tissues. X-rays are taken during the operation to confirm that the bones are in position. Afterwards, the child is placed in a spica cast to maintain the proper hip position.

Follow-Up

Hip dysplasia and bracing requires careful monitoring. Typically this is done with serial ultrasounds at 6 weekly intervals in the brace, then X rays at the age of 1, 2, and 5yrs.

Outcomes

If diagnosed early and treated successfully, children can develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or a "duck-like" gait and decreased agility.

Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2 years.

Frequently Asked Questions

My child has hip dysplasia - will they be in pain?

Hip dysplasia in young children is typically non-painful, when children become older >6-8yrs then pain can occur.

How long will my child need their brace for?

This depends upon how they grow and how the hip dysplasia resolves. Typically the minimum time a brace is required is 3 months. However, it is not uncommon for children to require braces up to 12-18months in severe cases.

Will my child have a developmental/walking delay due to being in a brace?

Most children who have been in a brace will have a delay in their ability to walk, but they normally catch up very quickly when the brace is removed.

Can my child walk in the brace?

In a hippo or rhino brace, children can often stand or crab walk. They can also usually pull themselves up to stand.

Can my child do tummy time in the brace?

Tummy time is difficult in any brace or orthotic. When the brace is off, it is recommended to encourage this as much as possible.

What is my child’s risk of arthritis in the future?

If hip dysplasia is detected early and treated successfully, there is a low risk of arthritis, however, if there is residual dysplasia, or if the condition is detected late, this increases the risk of arthritis.