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What is it?

The term hip dysplasia is used to describe a condition affecting the mobility and stability of the hip joint.

Other Common Names:

  • Hip Dysplasia
  • Developmental Dysplasia of the Hip
  • Congenital Dislocation of the Hip
  • “Clicky hips”
  • “Loose hips”
  • Hip Dislocation

Hip Anatomy

The hip joint is a ball and socket joint made up of the acetabulum of the pelvis (socket) and the head of the femur (thigh bone). Acetabular hip dysplasia is when the acetabulum does not develop properly and is too shallow to adequately support the head of the femur.

Types of Hip Dysplasia

Hip Dysplasia often presents early in life such as in infancy, but can arise during adolescence or adulthood. When left untreated, hip dysplasia can lead to long-term disability.

Developmental Dysplasia of the Hip (DDH)

This type of hip dysplasia affects infants and children and usually develops around the time of birth. The prevalence of this condition is approximately 1 in 100.

Acetabular Hip Dysplasia

This type of hip dysplasia is usually diagnosed during adolescence or adulthood and is because the acetabulum is too shallow and does not fully support the head of the femur. In the adult population, the prevalence of hip dysplasia is relatively uncommon with the estimated prevalence being only 0.1% in the US.

Diagnosis

Diagnosis is determined based on a thorough subjective and objective history. Imaging is used to quantify the degree of severity.

During your assessment, your physiotherapist may ask you questions such as whether you had a family history of hip dysplasia, if you were born in breached position, or if you had “clicky” hips as a child. From here, your physiotherapist will perform a physical examination where they will assess for hypermobility, hip range of motion, and evaluate your overall level of function.

Your physiotherapist or treating general practitioner may also request an X-Ray to evaluate the Lateral Centre Edge Angle (a line of best fit found on the radiograph running from the femur to the acetabulum.)

Although universal agreement has not been reached, these angles can be interpreted as follows:

  • <24 degrees: Borderline acetabular dysplasia
  • <18-20 degrees: Definite global acetabular dysplasia

In infants and children, radiographs can also be used to monitor hip joint development and maturation.

Signs and Symptoms

Symptoms of hip dysplasia usually emerge during adolescence or young adulthood if not detected during childhood. These may include:

  • Limping
  • Pain in the groin area or outside of the hip
  • Pain that increases with activity and eases with rest
  • A sensation of catching, snapping or popping
  • A loss of range of motion
  • Difficulty sleeping on the affected side

Conservative Management

Physiotherapy

Physiotherapy can be used to help build support for the hip by increasing muscle strength. This may include a progressive strengthening program for the muscles around the hip such as the hip extensors and external rotators, as well as the abdominals.

Physiotherapy can also play a role in improving joint position awareness as well as postural correction to help decrease loading onto the hip and reduce pain.

Treatment for this condition is highly individualised and any activity placing undue stress onto the affected hip or that increases pain should be avoided.

Other Management Strategies

Other management techniques may include:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
    • For the management of pain relief short term
  • Weight loss
    • To decrease joint load
  • Activity Modification
    • Such as the avoidance of high impact sports to reduce the risk of further injury.
  • Gait Aids
    • Where individuals are heavily affected, the prescription of a walking stick or cane may be indicated to offload the hip joint
  • Non impact sports such as Pilates, Swimming or Cycling
    • Can be used to maintain healthy activity levels

Orthopaedic Management

If symptoms are non-responsive to physiotherapy, and if symptoms are heavily impacting your daily activities, then a referral to a specialist as well as further imaging (i.e. Magnetic Resonance Imaging (MRI)) may be recommended.

Depending on the severity of hip dysplasia, surgical interventions may be recommended to help build stability for the hip.

References

Jorgensen MD, Frederiksen SB, Sørensen D, et al Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study BMJ Open 2021;11:e052486. doi: 10.1136/bmjopen-2021-052486

Muddaluru, V., Boughton, O., Donnelly, T., O’Byrne, J., Cashman, J., & Green, C. (2023). Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age. SICOT-J, 9, 25. https://doi.org/10.1051/sicotj/2023020

O’Brien, M. J. M., Jacobsen, J. S., Semciw, A. I., Mechlenburg, I., Tønning, L. U., Stewart, C. J. W., Heerey, J., & Kemp, J. L. (2022). Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis. International journal of sports physical therapy, 17(6), 988–1001. https://doi.org/10.26603/001c.38166

Pun S. (2016). Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia. Current reviews in musculoskeletal medicine, 9(4), 427–434. https://doi.org/10.1007/s12178-016-9369-0

Tao, Z., Wang, J., Li, Y., Zhou, Y., Yan, X., Yang, J., Liu, H., Li, B., Ling, J., Pei, Y., Zhang, J., & Li, Y. (2023). Prevalence of developmental dysplasia of the hip (DDH) in infants: a systematic review and meta-analysis. BMJ paediatrics open, 7(1), e002080. https://doi.org/10.1136/bmjpo-2023-002080