Hip dysplasia (developmental dysplasia of the hip, or DDH) is a malformation of the hip joint and ranges in severity from mild hip instability to complete hip dislocation. If both hip joints are affected, the condition is referred to as bilateral dysplasia. If only one hip is affected, it is referred to as unilateral dysplasia.
Surprisingly, most people first hear of hip dysplasia in connection with dogs. Humans and dogs share about 80 percent of the same genes, so hip dysplasia is a significant issue in humans, too. In fact, one in 1,000 babies is born with hip dysplasia, but only 12 percent have unstable hips past the age of two months.
However, hip dysplasia is not confined to infants and pets. Adults, particularly women, can be diagnosed with hip dysplasia. About 85 percent of patients with dysplasia of the hip are female.
Pediatricians screen for hip dislocation and/or instability in newborn babies before sending them home from the hospital. If hip dislocation is found, it's usually easily treatable with a special harness worn for three months. Hips that are found to be normal at newborn screenings can go on to reveal dysplasia later in life, due to an ongoing abnormal development of the hip joint — hence the term "developmental dysplasia of the hip." Depending on the severity of the condition, it can cause pain, limping, clicking, difficulty walking and, ultimately, arthritis of the hip.
Symptoms of hip dysplasia.
Symptoms of adult hip dysplasia can include:
- Activity-related pain in the hip region
- Difficulty walking, or decreased walking endurance
- Feeling a grinding sensation in the joint
- Hearing a clicking or clunking sound, even if painless
- Loss or limitation of the hip joint's range of motion
- Pain in the groin region
- Pain in the outer buttock or thigh
- Sensation of giving way, catching or locking
- Weakness, or giving way, in the leg/hip
Hip dysplasia is more commonly diagnosed in women than men, is most common in the left hip than the right and is most often seen in firstborn children and in families who have had prior children born with hip dysplasia. Dysplasia is the number one predisposing factor to the development of degenerative arthritis of the hip in adults. The principal goals of treatment are to alleviate pain and to postpone the onset of arthritis.
Once the diagnosis is suspected by a patient's physician, the best first step is an X-ray of the pelvis that includes both hips. Unfortunately, many subtle, and symptomatic, cases of dysplasia are missed on screening X-rays. An X-ray with dysplasia will show a shallow socket (or acetabulum), an inclined socket, a femoral head (or ball of the ball-and-socket joint) that appears too large for its socket and associated malalignment of the femoral head or both. Often, an associated impingement of the upper leg bone (femur) is noted.
During the physical exam, hip discomfort during movement (especially flexion, adduction and internal rotation), clicking (during flexion, abduction and external rotation), limping and differences in leg length may be noted.
Nonsurgical treatment options.
The first goal of treatment is to attempt to eliminate symptoms with nonsurgical strategies, including activity modification, anti-inflammatory or other nonnarcotic pain medication, muscle strengthening exercises or weight loss (if recommended).
Surgical treatment options.
If nonsurgical treatment options do not provide the desired result, surgery is recommended as early as possible to prevent the onset of hip arthritis. In adults (women above age 15 and men above age 17), the preferred surgical option is repositioning of the socket (acetabulum) via an orthopedic procedure called periacetabular osteotomy or rotational osteotomy of the acetabulum. In approximately 70 percent of cases an associated resection of an impingement lesion is also performed and in approximately 10 percent of cases an associated upper femoral osteotomy (inter-trochanteric osteotomy) is useful.
Periacetabular hip osteotomy procedure.
Hip osteotomy is a surgical procedure that repositions and/or reshapes the bones of the hip, allowing for positioning alignment during weight bearing. Once the bones have been repositioned, the brunt of the patient's weight moves from damaged joint surfaces to healthier cartilage. Screws are put in place to keep the bone in its new place. These are removed after complete healing, usually after six months.
Why choose periacetabular hip osteotomy surgery?
The prolonged presence of hip dysplasia can ultimately lead to the onset of hip arthritis. This is the progressive wearing away of the cartilage of the joint. As the protective cartilage is worn away by the arthritis, bare bone is exposed within the joint. This can lead to increased pain with activity, limited range of motion of the hip, stiffness of the hip and walking with a limp.
By performing hip osteotomy surgery as early as possible before the onset of arthritis, the protective cartilage can be spared, decreasing both the future onset of pain and the potential need for a hip replacement.
Benefits of periacetabular hip osteotomy.
Periacetabular-osteotomy offers several benefits to patients including:
- Allows for future vaginal childbirth
- Blood supply to the acetabulum remains uninterrupted
- Does not dramatically change the shape of the pelvis
- Femoral neck bumps, or cam-impingement lesions can be removed at the same time
- Keeps the posterior column of the pelvis intact, allowing the patient to walk soon after the surgery
- Performed through only one incision
- Relief of pain is immediate and long lasting
- Surgeon can examine the acetabular labrum and repair it, if needed, through the same incision
Recovering from your surgery.
After surgery, patients typically stay in the hospital for four to six days and use crutches with minimal, light weight bearing on the affected leg for the first five weeks, followed by weight bearing to tolerance with two crutches for another two weeks and, finally, followed by transition to one crutch for several weeks.
Thereafter, a single crutch or cane is used until the patient can walk without a limp, which usually occurs between 10 to 12 weeks post op. Water-based physical therapy begins after week five, supplemented by land-based therapy. Straight-leg raising is prohibited for three months. Improvements in strength occur for up to 18 months after surgery. Unrestricted activities are permitted beginning at six months.
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