Hip Dysplasia

Most people with hip dysplasia are born with it. This is known as congenital dislocation of the hip and it's usually diagnosed in newborns and young infants. However, you can also be diagnosed with it later in life.

Your hip joint connects your thigh bone (femur) to your pelvis. The top of your thigh bone is shaped like a ball, and the ball sits in a socket in your pelvis. 

Hip dysplasia can happen if the hip joint is too shallow or is positioned so that the socket doesn’t fully cover the ball part of the thigh bone. This causes the ball of the thigh bone to slip in and out of place, causing wear and tear on the joint. Sometimes, the hip joint is only out of place a little bit, while in other cases it’s dislocated.

Doctors usually check for hip dysplasia in babies by moving the baby’s legs as part of regular checkups. Hip dysplasia can’t be prevented, but it can be spotted early and treated with less invasive options. Treating it early can lead to better outcomes, fewer complications and improved quality of life. 

Hip dysplasia may be misdiagnosed as hip impingement or another condition. Some studies have found that a patient may see more than three providers and have symptoms for five years before they are diagnosed with hip dysplasia. Therefore, if you suspect you or a loved one have hip dysplasia, it’s important to have regular checkups and watch for symptoms. 

Hip dysplasia causes and risk factors

Experts aren’t sure exactly what causes hip dysplasia, but certain factors increase risk:

• Genetics: People with a family history of hip dysplasia may be more likely to develop it.
• Breech birth: Babies born in the breech position (where the bottom or feet come out first) are at an increased risk. 
• High birth weight: Bigger babies are at higher risk.
• Gender: Females are more likely to have hip dysplasia than males. 
• Firstborn children: There’s a slight increase in risk for a firstborn child.
• Hormonal factors: Hormonal and other changes during pregnancy can affect how the baby’s hip joint develops. 
• Tight swaddling: Swaddling a baby with the knees or legs together increases risk for hip dysplasia. It’s best to give babies’ hips room to move.

The symptoms of hip dysplasia aren’t the same in everyone, but many people have:

• Limited range of motion: Trouble moving the hip joint fully, especially when crawling (infants) or walking or putting on shoes or socks (older children and adults). In babies, parents may notice that one hip joint moves more than the other during diaper changes.
• Uneven leg length: One leg may appear shorter than the other. 
• Clicking or popping: Hearing sounds or feeling popping or catching sensations during movement could be a sign of problems with the hip joint. 
• Pain or discomfort: Pain in the hip, groin or thigh, especially during or after physical activity. Pain could also make it hard to sleep. Pain is uncommon in babies but is more likely in older children and adults with hip dysplasia.
• Limping or favoring one side: Leaning to one side to reduce pain or discomfort can cause gait (walking) changes.
• Feeling like the hip is unstable: People with hip dysplasia may feel like their hip feels loose.

If you or someone you love has symptoms of hip dysplasia, talk to a health care provider. While hip dysplasia is usually found in babies, milder cases are harder to diagnose and might not be spotted until later. It’s sometimes diagnosed in older children, teenagers or young adults. 

Treatment may be more effective when the condition is diagnosed early. It can keep the hip from getting worse and can reduce pain and discomfort.

Hip dysplasia may affect one or both hips. To diagnose hip dysplasia, your provider will check the hip joint’s range of motion and stability. They will also ask about your medical history, including any family history of hip dysplasia and/or issues. 

After this, they may do other tests, including:

• Imaging studies: X-rays, ultrasound, CT scans and magnetic resonance imaging (MRI) can help evaluate the joint.
• Orthopedic evaluation: An assessment by an orthopedic specialist to evaluate joint stability, gait and overall joint health. 

There are various options to treat hip dysplasia – and it’s important to not ignore it. Untreated, hip dysplasia can damage the cartilage around the hip socket and cause a hip labral tear. It’s also more likely to lead to osteoarthritis and a hip replacement at a younger age. 

Treatment options include: 

• Observation: In young babies, your health care provider might watch to see if the hip joint develops properly. When babies are diagnosed early, observation and harnesses or braces (see below) usually correct the problem.
• Orthopedic devices: Pavlik harnesses can help hips develop properly in infants under 6 months of age. If they don’t work, an abduction brace may be an option. In adults, assistive devices can reduce stress and help with mobility.
• Lifestyle modifications: Maintaining a healthy weight, choosing low-impact forms of exercise like cycling or elliptical machines, being aware of your posture and keeping your weight even across your hips can help.
• Pain management: Over-the-counter (OTC) or prescription pain relievers, hot/cold therapy, gentle exercises and injections can help lessen pain. 
• Physical therapy: A therapist can help with strengthening and range-of-motion exercises, pain management techniques and education on how to protect your hip.

What are the surgical options for hip dysplasia?

If these treatments do not help, surgery may be needed.

Depending on how severe hip dysplasia is in you or your child, your provider may recommend:

• Hip arthroscopy: In this minimally invasive procedure, surgeons insert a small camera through tiny incisions to assess and treat the hip joint.
• Periacetabular osteotomy (PAO): This hip-preservation procedure repositions the hip socket (acetabulum) to better cover the femoral head of the thigh bone. PAO often works well in younger people, but it can be a complicated procedure with a long recovery.
• Hip resurfacing: This treatment involves reshaping the damaged bone and placing a metal prosthesis over the end of the thigh bone. It can be a good choice for people with early-stage hip dysplasia. 
• Total hip replacement: In severe cases where there’s a lot of damage to the joint, your provider may recommend replacing the entire hip joint. 

After surgery, your care team will recommend a plan that can help you regain as much function in your hip as possible. Many rehab plans include:

• Care immediately after surgery to watch for complications and make sure the surgical site is healing properly.
• A cast to keep the hip joint in place as it heals.
• Physical therapy to help regain strength, flexibility and joint stability. 
• Advice on how much weight you can safely place on the hip. 
• Pain management to reduce discomfort and help the recovery process. 
• A gradual return to activities and exercises, monitoring progress closely and watching for any signs of discomfort. 

Recovering from hip dysplasia surgery can take several months to a year, sometimes more, depending on the type of surgery you had, your overall health and other factors. 

If you’re a teenager or adult with hip dysplasia, adjusting your lifestyle can help you live more comfortably. Here are a few tips: 

• Maintain a healthy weight to reduce stress on the hip joint.
• Engage in low-impact exercises (such as swimming, pool walking, elliptical training or cycling) to help keep your joint flexible without straining it.
• Choose a balanced, healthy diet. 
• Get plenty of rest, especially after you’ve been active. 
• Be mindful of your posture when you’re sitting, standing and walking so your hips are aligned properly.
• Consider using canes, crutches or other assistive devices so you’re not putting as much pressure on your hip when you’re moving around.
• Make adjustments to your home, such as adding handrails or using a raised toilet seat.
• Pace your activities so you don’t overexert yourself. 
• Wear supportive, comfortable shoes to cushion and align your hips. 
• Learn techniques to protect the hip joint, such as lifting items correctly and avoiding excessive twisting. 
• Use ergonomic chairs or cushions to support your hips when you’re sitting for a long time.
• Have regular follow-ups with your health care team so they can check the condition of your hip and treat any issues right away.