Hip dysplasia occurs when the hip joint doesn’t develop normally. It is a condition that may be recognized shortly after birth or later in life, which is then classified as adolescent hip dysplasia (AHD).
In a healthy hip joint, the ball of the hip, or top of the femur (thighbone), fits well and is contained within the socket in the pelvis. Hip dysplasia occurs when the ball and socket don’t fit together as they should. It can end up causing pain and, if left untreated, can lead to early arthritis.
Causes of AHD
The exact causes of abnormal hip joint development are not always known.
Adolescent hip dysplasia is a condition that most likely stems from an undiagnosed or untreated case of developmental dysplasia of the hip (DDH) in childhood. DDH can go unnoticed during infancy and childhood and may not cause any symptoms even when severe. Some children have hip dysplasia and don’t realize it. When the condition shows up in teens, it was likely present earlier in childhood.
Adolescent hip dysplasia typically appears as a child grows and becomes more active in the early teen years. This can be a result of a rapid growth spurt, the need for the hip to bear more load as the child gets bigger, or increased activity.
How Common Is AHD in Teenagers?
Those who are more likely to have adolescent hip dysplasia include:
- Females
- First-degree relatives of someone already diagnosed with hip dysplasia (25 percent chance of developing hip dysplasia)
- Children with neuromuscular disorders
Signs and Symptoms of AHD
Usually a child will begin to complain of pain in the hip or groin area when they are active. Other symptoms can include:
- Decreased ability to participate in sports or recreational activities due to hip pain or fatigue
- Increasing pain in the hip or groin
- Decreased endurance
- Hip joint catching or locking
- A limp or change in the child’s gait (how they walk)
- A difference in leg lengths
Symptoms vary from mild to severe. They are usually progressive and worsen over time.
Diagnosis of AHD
Doctors will perform a physical exam to diagnose adolescent hip dysplasia. To rule out other conditions and better view the hip anatomy, they may also use imaging. This can include one or more of the following:
- X-ray
- MRI (magnetic resonance imaging)
- CT (computed tomography) scan
Treatment of AHD
Treatment varies depending on how severe the hip dysplasia is. The care team at Cincinnati Children’s tailors treatment to each patient. Treatment can include:
- Activity modification
- Physical therapy
- Anti-inflammatory medications
- Surgery
Surgery is often recommended to increase stability of the hip, alleviate pain, and prevent or delay the need for total hip replacement. The most common surgery for adolescents to young adults with hip dysplasia is periacetabular osteotomy (PAO).
Surgery typically involves reshaping and/or repositioning the hipbones to create a normal hip socket. PAO is often performed along with other procedures that help restore the hip joint, such as hip arthroscopy.
At Cincinnati Children’s, we treat patients with adolescent hip dysplasia ranging in age from the early teens up through their 40s. We treat adults with the condition because hip dysplasia is a condition that starts in childhood. We have extensive experience managing the disease over a patient’s entire lifetime.
Recovery from Surgery for AHD
For patients who are in the teen to adult years, rehabilitation after surgery typically consists of six months of physical therapy. Individuals often return to selected activities in four to six months. Overall recovery continues up to one year. The most intensive part of recovery is in the first three months after surgery.
While the bones are healing, for the first four to six weeks to three months, patients are not able to put their full weight on the operated leg. Crutches are usually used during this time. Your doctor will let you know when physical therapy can start but usually patients may bear weight and begin range of motion as early as four to six weeks after surgery. Exercises will strengthen the hip joint and prepare the hip to carry weight again.
Long-Term Outlook
For patients undergoing surgery, the long-term results of PAO and associated procedures are very good. The most common benefit is relief of pain so individuals can maintain or increase their hip function. Results can vary depending on age and how severe the disease is, but in general outcomes are as follows:
- Ten years after surgery, more than 90 percent of patients continue to enjoy a successful outcome with relief of pain.
- Twenty years after surgery, 75 percent will have continued relief of pain and their condition will not have progressed to arthritis.
Some patients may develop arthritis later in life. Others may need a hip replacement in the future depending on how advanced the dysplasia was at the time of surgery. Hip replacement has improved the quality of life, function and pain for patients previously thought to be too young for hip replacement when the joint is unable to be preserved.
We monitor overall health of the joint with ongoing follow-up appointments. There is no age limit for continued follow-up, but care may be transitioned to an adult facility when appropriate for select patients.
