Hip Dysplasia - An Overview

Hip dysplasia is a fairly common medical condition that dog owners may know about, since this hip deformity affects canines relatively frequently. Parents of young babies may know that their pediatrician checks for this condition too, starting at the six week checkup. But, what exactly does hip dysplasia entail? What are the symptoms, how is this condition diagnosed and treated, and what can the consequences actually be?

Hip Dysplasia: What It Is

Hip dysplasia — from the name, you may guess that this condition pertains to the hip, and that has something to do with displacement. But what exactly is this condition? Look around the internet, and you will find all kinds of information:

• The International Hip Dysplasia Institute says that “hip dysplasia means that the bones of the hip joint are not aligned correctly”.

• The Mayo Clinic describes the condition as “a hip socket that doesn't fully cover the ball portion of the upper thighbone”.

• The American Academy of Pediatrics says that hip dysplasia is a condition in which the “femoral head has an abnormal relationship to the acetabulum”.

• Wikipedia is — think of it what you will — a popular source of information for many people. It says explains that hip dysplasia is a “congenital or acquired deformation or misalignment of the hip joint”.

• Their entry on canine hip dysplasia does a better job of explaining the condition to lay people, and says that hip dysplasia is an “abnormal formation of the hip socket that, in its more severe form, can eventually cause crippling lameness and painful arthritis of the joints”.

There are many different names for this condition, which can be congenital (present at birth) or acquired later in life. Developmental Dysplasia of the Hip (DDH), Hip Dislocation, Congenital Dislocation of the Hip (CDH), loose hips and clicky hips are among the names doctors and lay people use to describe this condition.

Why does one condition go by so many different names? While it is clear that hip dysplasia involves an atypical formation of the hip joint that affects its functioning, the degree to which it does so varies greatly from patient to patient. Some people with hip dyspasia have from a mild form of the condition that can easily be missed during routine infant screenings, while others find themselves in a situation in which the hip bone is severely malformed and the femur head — the “ball” part of the thigh bone that is supposed to fit into the hip socket — isn't connecting to the hip bone at all.

Hip dysplasia affects thousands of people, from newborn to elderly, every year. Around one in 20 full-term babies suffers from a some form of hip instability, while two to three of every thousand babies will need treatment for the condition. Hip dysplasia is the most common cause of hip arthritis in adults, and the hips will wear out more quickly in people with hip dysplasia too, necessitating hip replacement earlier in life. Hip dysplasia can be unilateral, affecting only one hip, or bilateral, affecting both hips. The condition is more common in females than in males.

I am a woman, now in my thirties. I was diagnosed with hip dysplasia during infancy, but I grew up knowing next to nothing about the condition — which didn't functionally affect me, but if I wanted to get out of PE classes, it'd claim that it did. “The doctor made you wear this huge cushion in between your legs to spread them and help your hips develop properly,” my mother told me.

Other than that story, which I heard many times, I was told I might need some kind of operation in my early twenties. My grandfather, who apparently had the same condition, had a hip replacement operation when he was already old — there is, you see, a hereditary component to hip dysplasia, though there are no hard and fast rules about who will end up with the condition.

That's all I knew, for a very long time. Then, I started experiencing hip pains at night. Sometimes my knees hurt too. I got through my childhood, teens, and twenties without thinking about hip dysplasia but then the condition apparently finally caught up with me. This can happen. If it happens to you, and you start to experience pain, clicking noises, or range of motion issues, please seek medical attention — if you know you were diagnosed with the condition as a child, but also if you weren't or are not sure.

Hip Dysplasia In Infants — Diagnosis And Treatment

The Diagnosis of Hip Dysplasia

A family history of hip dysplasia or extremely flexible ligaments, being a breech baby, and orthopedic problems including club foot, are risk factors for hip dysplasia. Girls are affected more often than boys, and firstborns are at a higher risk as well. Hip dysplasia is routinely screened for during infancy in some countries, while other countries prefer to screen only if certain risk factors are present.

Initially, a baby's hips may be moved around by a pediatrician to check if a questionable “click” can be heard. If so, further screening will involve ultrasound or X-ray pictures — often at three months of age. These diagnostic measures will determine the extent of hip dysplasia as well as enabling a diagnosis.

This is why the International Hip Dysplasia Institute describes hip dysplasia as a “silent condition”. But the fact that hip dysplasia is highly unlikely to form a problem for your infant does not mean that the condition is harmless. Hip pain, a limp, and hip joints that wear out at a much faster rate than normal can be the result in adults.

Early detection and treatment can usually prevent these problems, so facilitating those steps is important. If you live in a country that doesn't pay meticulous attention to their infants' hips (like many European countries do), there is nothing to stop you from asking your pediatrician to check your baby's hips during a routine well-baby visit, especially if your baby has certain risk factors for hip dysplasia.

Parents, too, can play an important role in the diagnostic process. Symptoms of hip dysplasia you may notice in your infant include:

• Asymmetrical creases in the skin of your baby's buttocks.

• One leg appears to be shorter than the other.

• The hip or hips click or pop — though this can be due to other conditions as well.

• The baby's legs may not be able to spread fully, which you may notice during diaper changes.

• A limp, or “waddling like a duck” may be noticed after the baby starts walking.

Treatment Options for Hip Dysplasia

Non-surgical treatment options that aim to push the hip into a better position and try to enable correct hip joint development are most common in infants under the age of six months. There are several methods available, and the chosen method often depends on the country in which treatment is conducted.

A Pavlik Harness vaguely resembles weird dungarees. It keeps the hips and knees bent and the legs spread wide apart. Other, less flexible harnesses can also be used. A Frejka pillow is a big pillow held up by straps that serves the same purpose. Traction is also used to stretch the ligaments, particularly in Asia and Europe, and usually before surgery. This involves holding the legs up with a device, or placing a pillow under the legs and applying traction length-ways. Traction is controversial, because it is not clear if it actually helps to promote proper hip development in infants.

A closed reduction is usually performed on children aged 24 months or younger. This operation is done under general anesthesia. After cutting the abductor tendon, the surgeon pushes the “ball” of the upper thigh bone back into normal position. The child is then placed into a so-called spica cast to force the hip to stay in proper alignment.

In an open reduction, tissues that prevent the ball (femur) from going into the socket are removed. There are two variations of this procedure, suitable for different ages and situations. Sometimes, it involves reshaping the hip socket. 

Osteotomy refers to the reshaping of a bone. A pelvic osteotomy involves the reshaping of the hip socket, while a femoral osteotomy refers to reshaping the femur, or ball of the thigh bone, which needs to fit into the hip socket. Both these procedures may also be combined with either open or closed reductions.

Hip Dysplasia's Long-Term Effects And Treatment Options For Adults

You may be an adult already diagnosed with hip dysplasia, an adult with apparent hip problems but with no diagnosis, or the worried parent of a child diagnosed with hip dysplasia simply wanting a glimpse of what the future may bring.

Your doctor is invaluable in all these situations. Parents of kids who were recently diagnosed with hip dysplasia will already have an appropriate doctor at their side, while adults may need to see their family doctor to be referred to a specialist. If this is you, do not ignore your symptoms and instead seek timely medical advice.

It is important to note that these symptoms can have other causes too. If you were already diagnosed with hip dysplasia as a child, the probable cause is obvious. If not, other diagnoses are also quite possible.

Hip Dysplasia Treatment In Adults

Once you have been diagnosed and the extent of your hip dysplasia becomes clear, there are various treatment options.

Hip preservation surgery, known as periacetabular osteotomy or PAO for short, is a surgery that involves reorienting the hip socket to bring it into a better position to cover the femoral head. This is the ball of the thigh bone that should be inside the hip socket.

After this is done, screws are placed into the hip socket to hold the femoral head in place while you heal. In some cases, cuts are made in the bone to facilitate a better hip alignment. This surgery is often performed in hip dysplastic adolescents and young adults and is very successful if not too much damage was done to the hip cartilage. If you don't suffer from bad arthritis, PAO may be an option even if you are already in your forties.

Joint replacement surgery, or arthroplasty, is suitable for adults with more extensive damage. It relies on artificial parts to replace the damaged joint, either only in part (“hip resurfacing”) or the traditional hip replacement.

Non-surgical options may also help you. Adults who are overweight benefit from weight loss. Sports like swimming and cycling will support your hip joint rather than causing further damage — you may need to avoid high-impact sports that place pressure on your damaged hip joint, in consultation with your physician.

Joint injections to slow down damage and specialized physical therapy can also be of help to many adults with hip dysplasia, either as an alternative to surgery, in order to delay surgery, or while you are on a waiting list for a surgical option.

Some hip dysplastic adults use yoga to maintain flexibility and acupuncture to reduce their pain. Alternative treatments may help you, but it's important to talk to your doctor to make sure that any physical activities you engage in do not actually speed up damage done to your hip joint.

Pain killers are often mentioned as a disease management option for canine hip dysplasia — in other words, for dogs. I don't see it mentioned for humans very often, but over-the-counter or prescription pain medications may certainly be a viable option for you... at least while you wait for a more permanent solution. Talk to your doctor about pain relief options if you are interested.