Adolescent Hip Dysplasia
1. Introduction
The hip is known as a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the femur (thigh bone) fits deeply into the socket, which is a curved portion of the pelvic bone known as the acetabulum. In an adolescent with hip dysplasia, the hip joint has not developed normally – the acetabulum is either too shallow or does not adequately cover and support the head of the femur (1). This abnormality can cause a painful hip and the early development of osteoarthritis, a condition in which the articular cartilage in the joint thins and increased contact between the bony surfaces may result in pain and restricted movement (1, 2).
Adolescent hip dysplasia usually occurs in young people with a history of developmental dysplasia of the hip. This is a condition that occurs at birth or in early childhood. Although newborn babies and infants are routinely screened for problems with their hip joints, in some cases these remain undetected or are mild enough that they are left untreated. These patients may not show symptoms of hip dysplasia until reaching adolescence. This is where the term adolescent hip dysplasia is most appropriately used.
Frequently Asked Questions
- Adolescent hip dysplasia is a result of an abnormality of the hip joint anatomy resulting in pain in the hip with occasional instability.
- Severe hip dysplasia is not common.
- Around 3% – 5% of the general population have evidence of some hip dysplasia (2).
- It is worth noting that hip dysplasia can remain asymptomatic (not give you pain or restriction) and not everyone is affected equally (3).
- Moderately.
- Adolescent hip dysplasia is not linked to any other serious medical conditions.
- In severe cases, or where there has been a progressive change to the hip joint, surgery may be required (5).
- We recommend an assessment with a musculoskeletal physiotherapist to identify the severity of the condition and the correct course of treatment.
- Adolescents who were born breech (bottom first) are more likely to have hip dysplasia.
- Females are three times more likely than males to have hip joint dysplasia.
- Adolescents who have a sibling or other family member with hip dysplasia may be more likely to develop the condition (2, 4).
- Pain in the groin area, buttock or front of the thigh.
- Pain may also be felt at the front of the knee or top of the shin.
- Pain that results in a limp, often decreasing weight on the painful leg during the walking cycle.
- Pain is usually worse with activity, particularly activities that involve rotating or weight-bearing for longer periods on the affected leg.
- The pain may be accompanied by sensations of locking, clicking or catching within the joint (3).
- Modifying or reducing the activities that cause or increase the pain may help settle symptoms over time.
- Weight loss or maintaining a healthy weight can help to reduce the load through the hip and reduce pain.
- Exercises to strengthen the muscles that support and stabilise the hip are likely to be helpful.
- Oral pain relief or anti-inflammatory medication is taken as advised by your doctor or pharmacist may help reduce pain (5).
- This will depend upon several factors including, but not limited to, medical/lifestyle factors, stage of injury, your ability to follow your rehabilitation, etc.
- Non-surgical treatment will be recommended if hip dysplasia is mild and there is no evidence of damage to the hip joint (6).
- Surgical treatment may be required in more severe cases, or in those that have progressive pain that has not settled with the right conservative treatment(s) (5).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
Hip dysplasia is not usually painful in childhood. However, during adolescence and early adulthood, the forces placed through the hip can result in earlier-onset degenerative changes that may result in symptoms including:
- Pain that is felt in the groin, buttock, front of the thigh or knee joint.
- Pain that may be mild initially but progress over time and become more obvious with certain activities.
- Stiffness or reduced range of movement in the hip when performing certain activities such as dressing or putting on shoes and socks.
- Pain that may be accompanied by the sensation of clicking, catching or locking in the joint (2, 3).
3. Causes
Adolescent hip dysplasia usually occurs as the result of an initial development abnormality of the hip in early childhood. There are several proposed causes of adolescent hip dysplasia which include (1, 2, 4):
- Genetic joint laxity.
- Structural abnormalities – this can include a shallow hip socket (acetabulum), irregular shape to the head of the femur, abnormal rotation of the hip joint or an abnormal angle between the head of the femur (ball) and shaft of the thigh bone.
- Problems in childbirth.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing symptomatic adolescent hip dysplasia. It does not mean everyone with these risk factors will develop symptoms.
- Gender – females are three times more likely to have this condition than males.
- Breech pregnancy – babies that are born bottom first are more likely to then develop adolescent hip dysplasia.
- Genetics – having a sibling or family member with certain hip joint disorders may increase the risk of adolescent hip dysplasia.
- Race – adolescent hip dysplasia is more common in certain ethnic groups, such as native Americans and Sami (3,4).
5. Prevalence
The incidence of hip dysplasia is reported to range from 1.7%-20% in the general population, with most studies finding the incidence between 3%-5 % (2). Females have 2 -4 times increased relative risk of developing hip dysplasia than males. However, males with hip dysplasia tend to have a higher incidence of associated hip joint deformities such as changes in the angle of the femoral head and femoral shaft, or thickening of the femoral neck (known as a cam deformity) (2).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your physiotherapist or doctor may perform certain movements that flex and rotate the hip joint to assess for pain, stiffness or catching/clicking within the hip joint.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. If adolescent hip dysplasia is suspected, your physiotherapist or doctor may recommend an X-ray or MRI scan to evaluate the degree of changes in the hip joint and confirm the diagnosis (3).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your hip dysplasia. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
8. Rehabilitation
Non-surgical (also known as conservative) treatment will be recommended if X-ray images show that the degree of dysplasia is mild, with minimal change or damage to the hip joint (6). Rehabilitation may focus on reducing or modifying activities that cause your pain, improving the strength and flexibility of muscles around the hip and pelvis, and monitoring your symptoms to determine whether there has been any progression (2).
Below are three rehabilitation programmes created by our specialist physiotherapists for adolescent hip dysplasia. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Adolescent Hip Dysplasia
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
These are initial exercises aimed at improving the strength and flexibility of muscles that insert around the hip and pelvis region. These may be performed 2 -3 times a day, working within a comfortable range of movement. This should not exceed any more than 3/10 on your perceived pain scale.
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These are more advanced strengthening exercises, targeting muscles that help to stabilise and support the hip joint, as well as addressing tightness of muscles around the legs, trunk and buttocks. These exercises may be performed 1-2 times per day, working within the limits of your pain. This should not exceed any more than 3/10 on your perceived pain scale.
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This is a more advanced programme for those aiming at a return to sport or other similarly challenging activities. The exercises here are aimed at strength and conditioning of the entire lower limb, from the ankle through to the hip joint, and are more functional, multi-joint movements. These can be performed 2-3 times per week as you may well be aiming to return to sport or activity in addition to this programme. This should not exceed any more than 3/10 on your perceived pain scale.
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10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
In cases where there has been significant change in the joint, or conservative treatment has not been able to help manage your pain, a consultation with an orthopaedic surgeon may be required. There are different surgical techniques that could be recommended, including periacetabular osteotomy, to help reposition the ball and socket joint, or hip arthroscopy where damaged or irritable tissue is removed from the lining of the joint.
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References
- Byrd, J. T. (2005). Operative hip arthroscopy. 229-235
- Pun S. (2016). Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia. Current reviews in musculoskeletal medicine, https://doi.org/10.1007/s12178-016-9369-0. 9, 427–434.
- Ellsworth, B. K., Sink, E. L., & Doyle, S. M. (2021). Adolescent hip dysplasia: what are the symptoms and how to diagnose it. Current Opinion in Pediatrics, 33, 65-73.
- Storer, S. K., & Skaggs, D. L. (2006). Developmental dysplasia of the hip. American family physician, 74, 1310-1316.
- Breidel, K. E., & Coobs, B. R. (2019). Evaluating and managing acetabular dysplasia in adolescents and young adults. Journal of the American Academy of PAs, 32, 32-37.
- McGovern, R. P., Martin, R. L., Kivlan, B. R., & Christoforetti, J. J. (2019). Non-operative management of individuals with non-arthritic hip pain: a literature review. International journal of sports physical therapy, 14, 135.
Other Conditions in
Hips & Pelvis, Paediatrics
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Proximal Hamstring Tendinopathy
Pain and weakness under the buttock or the back of your upper thigh caused by tendon issues.
Pelvic Girdle Pain
Typically seen in pregnancy causing pain, instability and limitation of mobility and functioning of the pelvic joints.
Pelvic Floor Dysfunction
The inability to effectively control the muscles of your pelvic floor, leading to issues with continence and pain.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Iliotibial Band Syndrome
Presents as pain on the outside of the knee, normally occurring because of overload due to prolonged or repeated bouts of exercise.
Hip Replacement Surgery
Replacement of the hip ball and socket joint, typically as a result of severe osteoarthritis or trauma.
Hip Osteoarthritis
Common age-related changes to the structure of the hip joint may be associated with pain, stiffness and loss of function.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Adductor-Related Groin Pain
Localised discomfort to the inner upper thigh and groin.