The hip is a ball and socket joint where the ball is the head of the thigh bone, which fits securely into its socket called the acetabulum. The fibrocartilage lining of the acetabulum is called the labrum, which helps form a deeper, more stable joint. The head of the thigh bone and the socket are lined with articular cartilage which aids in the smooth movement of the joint and protects the bones from rubbing together.
Hip dysplasia is abnormal development of the hip joint that creates a shallow hip socket which makes it easy for the hip to dislocate partially or completely. The mechanical stress on this shallow socket leads to failure of the cartilage-labrum junction, which can ultimately progress towards early (before age 50) arthritis of the hip. This abnormal hip joint anatomy creates added pressures on the surrounding ligaments, muscles and other soft tissues leading to chronic pain and limitations.
Usually dysplasia is diagnosed in childhood, but sometimes it escapes detection and creates problems for adolescents and young people when they find their hip hurts and/or they develop an early painful limp.
During early stages of childhood, the hip sockets are made of soft cartilage allowing for growth and development. Likewise, the surrounding ligaments are loose which allow them to accommodate and stretch for growing bones, tendons, and muscles. However, for a number of reasons, some genetic and some mechanical, the hip socket doesn’t deepen sufficiently and hardens into an abnormally shallow socket. This shallow socket in turn makes it difficult for the head of femur to stay in position, known as instability, which can lead to rapid wear and tear of the hip joint much sooner in one’s lifetime.
Hip dysplasia runs in families. Girls are twice as likely to be affected as boys. The incidence is 3-5% of the general population. The risk is higher for first born and breech born babies. Dysplasia can also be caused by injury to the hip joint later in one’s life.
Hip dysplasia is a common source of hip pain that is present in 20-40% of patients with hip osteoarthritis. Hip dysplasia is a common cause of labral tears.
- Activity related groin pain is the classic presentation of a labral tear and hip dysplasia.
- Pain with squatting, climbing, standing, and sitting for long periods.
- Pain on the side of the hip.
- Pain at rest and in sleep.
- A sensation of instability with weight bearing activity.
- Clicking, popping, locking, or catching sensation in the hip.
Diagnosis will include:
- Physical exam – specialized tests to determine the source of hip pain
- Imaging studies – X-rays to evaluate bone health and alignment; CT scans for a more detailed evaluation; and MRI to evaluate soft tissues injuries such as labral tears, which can be found about 77% of the time.
Infants are routinely screened for hip dysplasia. According to the International Hip Dysplasia Institute, nine out of ten cases of hip dysplasia are diagnosed in adolescence and adulthood. Hip dysplasia diagnosed later in life is the leading cause of hip replacement in young adults.
Treatment options depend on the age of the person and the amount of damage. Most people with hip dysplasia will need surgery at some point to improve hip function and prevent or treat early arthritis.
In young adults with mild dysplasia, the clinicians at LALL Orthopedics + utilize the latest technology in nonsurgical treatment options such as focused lifestyle modifications, directed physical therapy and cutting-edge regenerative medicine techniques (Stem-Cell Therapy or PRP injections) to help reduce inflammation and joint pain.
Hip preservation surgery is recommended to correct mechanical abnormalities of hip dysplasia that can help treat pain and limit further damage to the joint. The most common surgical procedure is an osteotomy which involves deepening of the hip socket to create a more normal and functional joint.
The most common type of osteotomy is called a periacetabular osteotomy. It is designed to preserve the natural joint and is very successful to improve hip longevity and quality of life. This procedure is typically reserved for people under 40 years of age. Patients older than 40 with poor range of motion, progressive cartilage damage and arthritis are not good candidates for a periacetabular osteotomy. Rather, they are likely to need a total hip replacement. When the labrum is damaged, minimally invasive arthroscopy may be used to repair the tear simultaneously.
The team at LALL Orthopedics + is a world leader in same-day combined hip realignment and arthroscopic hip labral repair surgery. The ultimate goal is to delay or remove altogether the need for hip replacement surgery in one’s lifetime.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified and triple fellowship-trained hip surgeon. Dr. Lall and the team at LALL Orthopedics + specializes in diagnosing and treating hip dysplasia. Schedule a hip consultation today.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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