Cedars-Sinai Blog
Treat Hip Dysplasia Before You Need a Complete Replacement
Hips are a vital connector in the human body. They anchor and power every upright movement from walking to running, jumping, squatting and throwing. Hip dysplasia, a malformed hip joint, can limit all these activities and lead to pain, limping, loss of function and arthritis.
The condition can develop at any time, but most cases are caught in early childhood, when it is called developmental dysplasia of the hip (DDH). As many as one in one hundred babies is born with and treated for this condition.
For others, the condition is more subtle and isn’t diagnosed until later in child- or adulthood. If left untreated it will, in most cases, lead to early-onset osteoarthritis.
In the U.S., it’s estimated that up to 40% of hip osteoarthritis results from hip dysplasia. If diagnosed and treated in time, many of these hips can be preserved in young adulthood.
Hip Dysplasia Explained
The hip is a ball-and-socket joint. The top of the thigh bone, or femur, ends in a round ball that fits into a socket in the pelvis. Tissue called cartilage provides a friction-free surface for these bones to contact one another during normal movement. Hip dysplasia is when the ball doesn’t sit securely or correctly in the socket. It’s often caused by a socket that’s too shallow, allowing the ball to move around too much or cause excessive force on a small area of the joint.
“That puts a lot of stress on the muscles, tendons and ligaments to try to stabilize the hip,” explained orthopedic surgeon Patrick Whitlock, MD, PhD, an expert in hip dysplasia. “That causes pain, discomfort, muscle fatigue and soreness. Eventually, these secondary stabilizers fail.”
Patrick W. Whitlock, MD, PhD
It also causes uneven wear on the hip joint’s cartilage, which over time leads to osteoarthritis, in which the cartilage is worn away and the thigh bone starts making direct, often painful, contact with the pelvic bone.
Hip dysplasia is thought to be genetic, and family history is a significant risk factor. Women are up to eight times more likely to suffer from the condition. Other risk factors include being the firstborn and being born breach, when the feet or bottom come out first rather than the head.
Many babies with hip dysplasia don’t require surgery. They can be successfully treated with a Pavlik harness, a kind of soft splint that holds the hips in place, allowing them to develop properly.
“I've had lots of patients say they never had any pain until they were 33 and now it’s severe.”
But when the dysplasia is diagnosed in older children or into adulthood, a specialized surgery is often required to correct the misalignment of the ball and socket.
“Sometimes the symptoms are subtle and people can get by,” said Whitlock, who directs Cedars-Sinai’s hip preservation program and specializes in treating pediatric, adolescent and adult cases of hip dysplasia, as well as other hip conditions and injuries. “I’ve had lots of patients say they never had any pain until they were 33 and now it’s severe. Others say they’ve had pain since they were teenagers—it just never got bad enough that they thought to get it checked out.”
Identifying and Treating Hip Dysplasia in Teens and Adults
Hip dysplasia has often gone misdiagnosed in teens and adults, particularly for women.
“If a doctor doesn’t know what to look for, a lot of X-rays are read as normal,” said Whitlock. “In the past, orthopedists often weren’t measuring the socket. They just thought it was bursitis or something like that. But physicians’ ability to diagnose the condition is improving.”
When a diagnosis is made before too much damage has been done—even up to the age of early 40s—a specialized surgery can save a patient’s hip and forestall, or even avoid, the need for a total hip replacement. Whitlock is a nationally recognized authority on this surgery, called a periacetabular osteotomy, or PAO.
“What we do is cut the socket entirely free from the rest of the pelvis,” explained Whitlock. “Then we reposition it to be centered over the ball so that all the weight-bearing forces of walking, running, kicking—whatever you’re doing—are being transferred through the maximum amount of cartilage on the ball and socket to minimize the wear on that cartilage.”
Whitlock says the procedure has proven very effective in decreasing pain, restoring function, slowing the progression of arthritis and preventing the need for hip replacement. But it’s a complicated surgery with a limited number of experienced practitioners.
“It’s a long and steep learning curve, and fairly significant complications can arise if the surgeon isn’t experienced,” said Whitlock. “It’s individualized to each patient and their particular anatomy. Performing the surgery many times and learning what to look for in each case can help the patient leave the operating room with the best chance of doing well and keeping that hip for the longest period of time.”
People experiencing hip pain shouldn’t suffer needlessly, says Whitlock. If your problem is dysplasia, an early intervention can be the difference between keeping your hip and having to replace it.
