Hip Dysplasia

What is it and how do I gain an accurate diagnosis and treatment plan?

What is Hip Dysplasia?

Hip dysplasia is a broad diagnosis that includes a spectrum of hip symptoms including pain, instability and shallowness of the hip socket. It is generally classified by a loss of conformity between the femoral head (ball) and the acetabulum (socket) of the hip joint. This can be due to abnormalities in their shape, size and/or orientation. 

Hip dysplasia is commonly misdiagnosed and can take on average 5 years and 3 healthcare providers for people with hip dysplasia to receive a diagnosis. It is associated with poorer function, sport & recreation and quality of life outcome measures and has an estimated prevalence of between 3-20% of the population. More severe hip instability and dislocation are more likely to occur during infancy, while a shallow but stable socket is more often diagnosed in adolescence or early adulthood. 

What does Hip Dysplasia look like?

Example of a healthy hip vs a dysplastic hip

Deep hip pain or a limp can be an indicator of hip dysplasia in adolescents and young adults, however this can also indicate other hip disorders. Two or more of the following symptoms increases the likelihood that hip pain may be caused by hip dysplasia.

  • History of ongoing deep anterior hip/groin pain (however this could also indicate labral tears, cartilage damage in the joint, or the hip flexor muscles)
  • Muscular ache on the side or front of the hip from overworked hip flexor and abductor muscles that are trying to provide more stability to the hip
  • Hip pain increases with walking, standing or running 
  • Pain at night 
  • A sensation of catching, snapping, popping, or locking that is usually painful

What are the risk factors for Hip Dysplasia?

  • Neonates with hip dysplasia: 75% Females 
  • 80% of people presenting for treatment of Hip Dysplasia are women
  • Hypermobility
  • Swaddling 
  • Primiparity & multiple births 
  • Breech 
  • Rural childbirth 
  • Early hospital discharge 
  • Hereditary/Genetics 
  • Left Hip 64% (when unilateral) 

What is the treatment for Hip Dysplasia?

Hip dysplasia can be managed both surgically and non-surgically, however non-surgical management should be attempted prior to surgical intervention. Treatment can be dependent on the type of dysplasia, and the age of diagnosis. 

Non-surgical treatment:

  • Education & advice including reducing aggravating loads, specific lifestyle and exercises modifications.
  • Targeted strengthening program: Sway correction, hip abductors, ER, IR strengthening, gym programming, standing stability progressions, multiplanar progressions, single leg work
  • Movement pattern retraining
  • In babies and infants treatment usually consists of long periods of bracing to help the hip develop in a more stable and aligned position (Pavlik harness) or surgery to realign the joint (open or closed reduction depending on age, spica cast)

In more severe cases of hip dysplasia, where non surgical management has failed or when the hip is very unstable (subluxation/dislocation) surgical intervention may be appropriate. This is when an orthopedic surgeon would become involved with your treatment plan. 

Surgical treatment:

  • Arthroscopy
  • Periacetabular osteotomy (PAO) 
  • Total Hip Replacement (THR)

Hip Dysplasia Summary:

  • Misdiagnosis is common as hip dysplasia often masks as FAI (femoroacetabular impingement), hip flexor pathology, GTPS (lateral hip pain), or groin pathology
  • Different types of hip dysplasia exist with unique presentations – there is no single rule in/out test and each type is treated differently so it is important to get an accurate diagnosis. This is where weight bearing x-rays are indicated for gold standard diagnosis. 
  • Non-surgical management should be attempted prior to surgical treatment
  • Treatment should be targeted to:
  • type of dysplasia
  • physical impairments
  • functional/athletic demands
  • Education and activity modification play an important role
  • Graduated, milestone-driven, high-level rehab is crucial prior to return to full function and sport

This is why a thorough assessment and correct referral for imaging or orthopedic intervention is crucial for the optimal management of hip dysplasia. Physiotherapy can help with this, and with establishing a specific rehabilitation program to reduce symptoms associated with hip dysplasia.

~ Elise McMahon