- International Hip Dysplasia Institute
- X-Ray Diagnosis
- Through my eyes: Bilateral hip dysplasia
- Learning more and finally seeing a doctor
- How my diagnosis changed my life
- Healthdirect 24hr 7 days a week hotline
- What is hip dysplasia?
- Symptoms of hip dysplasia
- Diagnosis of hip dysplasia
- Treatment of hip dysplasia
- Living with hip dysplasia
- Where to seek help
- Developmental Dysplasia of the Hip (DDH) | Symptoms and Causes
- What are the symptoms of hip dysplasia?
- What causes hip dysplasia?
- Signs that parents might notice include:
- Hip Dysplasia
- If you have hip dysplasia, you are not alone!
- What is adult hip dysplasia?
- How do I know if I have hip dysplasia?
- Is there a cure for hip dysplasia?
- Are there non-surgical treatments available for adult hip dysplasia?
International Hip Dysplasia Institute
Hip Dysplasia is usually diagnosed by an experienced physician using the combination of symptoms, hip examination, and x-ray findings. One study showed that adult patients with hip dysplasia may see more than three healthcare providers and have symptoms for five years before a correct diagnosis is made. This is improving because of increased awareness by physicians and through IHDI educational efforts. However, a second opinion may be worthwhile if you have continuing hip pain.
Hip pain or limp are usually the first signs of hip dysplasia in an adolescent or young adult. Occasionally a limp may occur without pain during walking because limping is one of the body’s natural methods of decreasing pain. However, these symptoms can also be caused by many other hip disorders.
Two or more of the following symptoms increases the likelihood that your pain is caused by hip dysplasia.
- Pain from hip dysplasia is deep in the front of the groin in four out of five patients with hip dysplasia– this may be caused by labral tears, cartilage damage in the joint, or painful hip flexor muscles (see anatomy and terminology).
- Muscle ache on the side of the hip or in front of the hip can also be caused by stabilizing hip flexor and abductor muscles that are overworked when the socket is shallow. (see anatomy and terminology).
- Hip pain increases when walking, standing or running in almost all patients with hip dysplasia.
- Pain at night when resting occurs in half of all patients with hip dysplasia
- A sensation of catching, snapping, popping, or locking that is usually painful. Four out of five patients with hip dysplasia report this.
Other characteristics of hip dysplasia:
- Pain in the thigh or buttocks is uncommon unless there is also pain in the groin or side of the hip.
- At first the pain may be mild or intermittent, but pain from hip dysplasia increases with time.
- The character of the pain may be sharp, or it may be a dull ache, or a combination of both from time to time.
Limping is common during the early stages of hip dysplasia symptoms. The most common cause of a limp is pain. However, a painless limp can occur because of weak muscles, joint stiffness, bone deformity, or because the limp relieves the pain.
A limp or pain does not necessarily mean that someone has hip dysplasia because limp and pain can be caused by many hip disorders. To learn more about adult related hip disorders click here.
The doctor may have you stand to look for pelvic tilt, leg length discrepancy, or muscle wasting. This is generally followed by moving the hip through a full range of movement. Motion is not normally limited by hip dysplasia although pain or muscle tightness is often noticed when the leg is spread away from the body – hip abduction.
During walking most patients will limp because of dropping of the affected side of the pelvis. This dropping may also occur when standing on the affected hip. This is called the Trendelenburg test.
A test called the impingement test causes a pinching sensation in almost all patients with hip dysplasia. This may occur when a torn labrum or the tender edge of the socket is pinched. The test for impingement is usually done by flexing the hip and then twisting the hip inwards to rub the femoral neck against the edge of the hip socket.
An x-ray can identify hip dysplasia by the shallow socket (acetabulum).
Bilateral hip dysplasia in a young adult woman. Note that the sockets are shallow and do not contain the ball (femoral head)
Normal hips in an adult woman. Note that the sockets are deep and contain the ball almost completely
X-rays can determine the severity of dysplasia, which helps to establish the need for surgery. There are several ways that the amount of dysplasia can be measured on x-rays.
A common measurement for the depth of the socket is the center-edge angle (C-E angle). The normal C-E angle is 25° or more.
X-rays also show whether hips are also displaced in an upward direction; this information is valuable because hips that are displaced upward usually wear out faster than hips that are not displaced upward.
An MRI may also be helpful to diagnose hip dysplasia and give the physician information on any damage to the cartilage and labrum.
Continue to Adult Treatment for Hip Dysplasia “
Through my eyes: Bilateral hip dysplasia
I imagined the ward and saw nurses hoisting a bandaged version of myself into a hospital bed. I pictured them draining me and doctors tinkering with ratchets bored into my bones. I imagined lonely days spent gazing out of the window at a seemingly endless parking lot.
I declined, and that was about that. In young adulthood, all the medical appointments stopped. The cave closed, and I hobbled from the mountain into the world. I increased the painkillers a little, improved the quality of my joint supports, and continued forward as silently as ever.
Learning more and finally seeing a doctor
I’ve kept my condition a secret when I’ve wanted to, and that has been a lot. Beyond my limp, there is nothing to suggest that I’m anything other than a normally functioning skeleton.
Share on Pinterest’I’ve gotten to know my particular pain.’
However, secrecy has left me isolated within my own body.
The awareness that I was forever conscious of my condition but understood so little of it was getting me down. The pain was growing ever worse, too.
I considered a walking stick, but did I need one, or would it just be an affectation to broadcast my condition, symbolic of a scream?
This question helped me commit to finding out more about my condition — for the first time as an adult.
By talking with friends and receiving messages of support on social media, I started to gain the confidence to make a doctor’s appointment.
I was nervous about seeing a doctor. Would they find anything, after all this time? Did inverted hips actually exist? Would they offer a means to get rid of the pain? This was a strangely frightening prospect for me. My relationship with my pain is masochistic. The pain, I’ve often thought, suits me.
I’ve gotten to know my particular pain. We are not friends, but the connection is not toxic either. It’s never guided my choices, but it understands what I am capable of. It tells me not to feel sorry for myself but reminds me that I am fragile and need to be careful with myself.
The pain has also been something to rally against — rage against, even. When I need it to, it makes me want to put one foot in front of the other again and to make me take one more howling step along. These are my legs. This is my pain. This is how I walk through life. Would I be the same person without it?
The doctor asked me, on a scale of 1–10, how bad the pain was. Ascribing pain on an arbitrary scale is an odd thing. It’s a mechanical numbness, a buzzing electric coil, hot custard over warm apple pie. It’s about a 6?
He sent me for X-rays. The nurse positioned me under the aperture apparatus with her cold hands on my hips.
I finally saw an X-ray of my pelvis and hips, and it was beautiful. I wanted to make it a stained-glass window. It was the first time I could look at what was troubling me. Instead of a curved ball and sockets, my hip joints fit into my pelvis like pins. I saw white mist around the joints: arthritis.
The results were returned. The doctor took the computer mouse to scroll through the notes on his monitor with all the body language of a sigh in his wrist.
“You have congenital bilateral hip dysplasia,” he said. “There’s wear and tear but nothing too much to worry about. Your extreme inflexibility around the area is causing you to pull on hamstrings and tendons, which are losing elasticity as you get older.”
“Take painkillers as you need them. Look into getting exercises from a physiotherapist to get those soft tissues stretched. That’s all I can say to help you.”
How my diagnosis changed my life
Seeing the X-ray images and having a diagnosis helped more than he realized. The answers were more than his brief prognosis. I now feel assertive with this condition. It is valid: it has a medical name, and I’ve found an institute.
Going to visit a doctor with a determination to learn more about my condition has been great. I am already increasingly comfortable living with my condition as a normal part of life, and I openly take pain medication and adjust any joint supports. And, if I’m asked about my condition, I’m happy to answer. I can point in the direction of an entire institute.
Today, I’m trying to follow the strength I see in my friends. I am positive in approaching my pain as part of a normal way of living, openly and without guilt, regarding my limitations or what I do to manage it.
I’m not seeking sympathy, but I don’t feel bad about voicing the times I do struggle. The pain is no longer negatively charged emotionally as a big secret.
I want to thank my friends — they know who they are — for letting me travel with them, now at our own pace, to the mountain’s open mouth.
All I need now is a pelvis bone tattoo on my forearm, and I’ll be booking an appointment soon.
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What is hip dysplasia?
The hip joint consists of the top end of the thighbone (femur) which fits into a curved part of the pelvis (the acetabulum) like a ball and socket. In hip dysplasia, the acetabulum is too shallow so the hip becomes dislocated or unstable. The condition is also called ‘developmental dysplasia of the hip (DDH)’ or ‘clicky hips’.
Hip dysplasia in babies is more common if the baby had a breech birth or if there is a family history of the condition. It is more common in girls and firstborn children.
Hip dysplasia diagnosed early in life can be corrected and usually fixed completely. But if not treated in childhood, hip dysplasia can damage the joint over the years and is a leading cause of hip pain and arthritis in older people. People with hip dysplasia may eventually need a hip replacement.
Symptoms of hip dysplasia
Hip dysplasia in babies is not painful. Symptoms include:
- a hip joint that clicks when it’s rotated
- uneven legs or skin creases near the buttocks
- late sitting or walking
- uneven walking
In adolescents and adults, the main symptom of hip dysplasia is sharp pain, especially in the groin area. It’s common after sport and can be worse when you’re standing up from a seated position, climbing in and out of a car, going downstairs, or if you suddenly rotate your hip.
Diagnosis of hip dysplasia
All newborn babies are examined for hip dysplasia in their first few days of life. These tests are repeated again at 6 weeks and at every appointment with the doctor or child and family health nurse. If they detect a problem or if your baby is at high risk of hip dysplasia, they may order an ultrasound.
In older children and adults, a physical examination and an ultrasound are used to diagnose the condition. An MRI or CT scan may be necessary to have a closer look at the acetabulum and assess any damage.
Treatment of hip dysplasia
Treatment depends on your age, how severe the condition is, and whether you have developed arthritis.
In babies, the wearing of a soft brace (known as a Pavlik harness) for 6 to 10 weeks may help the hip develop normally. A small number of babies may need to have surgery or spend time in a plaster cast.
In adolescents and adults, the aim of treatment is to preserve the hip for as long as possible. You may receive anti-inflammatory medicines, steroid injections and physiotherapy to help manage the condition.
Surgery can sometimes be used to reposition the acetabulum or repair the cartilage. But in some cases, the person may need a hip replacement.
Living with hip dysplasia
Gently moving and stretching the hip will help to keep it lubricated and moving well. A physiotherapist can give you an exercise plan. Physical activity and strengthening exercises will help you stay healthy, but avoid running and impact sports as they put too much pressure on the hip joint.
Walking with a cane may help in the later stages of hip dysplasia. One to 2 of every 5 adults with hip dysplasia develop osteoarthritis, a leading cause of disability. Find out more about living with osteoarthritis here.
Where to seek help
- your GP
- your physiotherapist
- a maternal child health nurse at Pregnancy, Birth and Baby on 1800 882 436.
- International Hip Dysplasia Institute
- Arthritis Australia
Developmental Dysplasia of the Hip (DDH) | Symptoms and Causes
What are the symptoms of hip dysplasia?
Common symptoms of developmental dysplasia of the hip (DDH) may include:
- The leg on the side of the dislocated hip may appear shorter.
- The leg on the side of the dislocated hip may turn outward.
- The folds in the skin of the thigh or buttocks may appear uneven.
- The space between the legs may look wider than normal.
In hip dysplasia, the socket (acetabulum) is too shallow and the ligaments too loose, allowing the ball of the thigh bone (femoral head) to slip partially or completely in and out of the hip socket. The risk for hip dysplasia and hip instability increases with any situation that stretches the baby’s hip ligaments (an issue of stability) or causes the legs and hips to be positioned so that the ball of the thigh bone slips out of the hip socket (an issue of shape).
What causes hip dysplasia?
The exact cause of DDH is unknown, but it’s considered to be a “multifactorial trait,” meaning there are many factors involved. The risk of developmental hip dysplasia is higher for:
- children with a positive family history of DDH in a first-degree relative
- females, who have looser ligaments than males
- first-born babies, whose fit in the uterus is tighter than in later babies
- breech babies, whose constrained position tends to strain the joint’s ligaments
Hip dysplasia in babies is most frequently discovered at the time of newborn examinations by physicians but dysplasia and dislocation can develop after this time in some children. This is why hip dysplasia is greatly considered developmental. It is also hard to detect because hip dysplasia is known as a “silent” condition. It does not cause pain in babies and doesn’t normally prevent them from learning how to walk at a normal age.
Signs that parents might notice include:
A baby with Swayback. Note the strong curve in the lower back.
Asymmetrical buttock creases can suggest hip dysplasia in infants but, like a hip click, an ultrasound or x-ray study will need to be done to determine whether the hips are normal or not.
Continue reading about Asymmetry.
Hip clicks or pops can sometimes suggest hip dysplasia but a snapping sound can occur in normal hips from developing ligaments in and around the hip joint.
Continue reading about Hip Clicks.
Limited Range of Motion
Parents may have difficulty diapering because the hips can’t fully spread.
Pain is normally not present in infants and young children with hip dysplasia, but pain is the most common symptom of hip dysplasia during adolescence or as a young adult.
A painless but exaggerated waddling limp or leg length discrepancy are the most common findings after learning to walk. If both hips are dislocated, then limping with marked swayback may become noticeable after the child starts walking.
Learn about Diagnosis “
Hip and pelvis (ball and socket)
Hip dysplasia is an abnormality in the hip joint. In people with this condition, the femur (thigh bone) does not fit together with the pelvis as it should.
Hip dysplasia can damage the cartilage, the tissue that cushions these bones in the joint. It can also cause pain and issues, ranging from an unstable joint to dislocation (the bone slides out of place in the joint).
How common is hip dysplasia?
About 1 of every 1,000 babies is born with hip dysplasia. Girls and firstborn children are more likely to have the condition. It can occur in either hip, but is more common on the left side.
What causes hip dysplasia?
The hip joint is a ball-and-socket configuration that attaches the femur to the pelvis. In people with hip dysplasia, the femoral head (top of the femur) does not line up properly with the curved socket in the pelvis. In some cases, the socket is not deep enough to hold the femoral head in place.
Most people who have hip dysplasia were born with the condition. Hip dysplasia can develop if the baby’s position in the womb puts pressure on the hips. It can also be genetic (passed down in families).
When people are born with this condition, it is called developmental dysplasia of the hip or congenital hip dislocation.
What are the signs and symptoms of hip dysplasia?
Signs and symptoms of hip dysplasia include:
- Pain in the hip
- Loose or unstable hip joint
- Limping when walking
- Unequal leg lengths
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If you have hip dysplasia, you are not alone!
Its the most common cause of hip arthritis before the age of 50. Nine out of ten cases of hip dysplasia are diagnosed during adolescence or adulthood. Doctors are more and more aware of this common condition that often escapes detection during childhood. In fact, this silent form of hip dysplasia is the reason for 5% to 10% of all total hip replacements in the USA.
What is adult hip dysplasia?
Adults with hip dysplasia have a hip socket that is too shallow to support the ball of the hip. The ball is called the femoral head and the socket is called the acetabulum. Some adults have leftover problems from childhood hip dysplasia but most adults never knew they had a problem until their hip started hurting.
A joint that is the wrong shape or shallow will wear out faster than one that has a more normal shape. The smooth surface of the joint has a thin layer of cartilage that can’t be repaired or re-grown by the body. This cartilage surface needs to last a lifetime, or stiffness and pain occurs as the joint wears out.
How do I know if I have hip dysplasia?
The first sign of hip dysplasia in an adolescent or young adult is typically hip pain and/or a limp. This is usually in the groin area and/or lateral aspect of the hip. Pain is usually increased by activity and diminished by rest. Often there is a sensation of catching, snapping or popping in addition to pain with activities. Adult patients with hip dysplasia may see more than three healthcare providers and have symptoms for five years before a correct diagnosis is made, so you may want to consider getting a second opinion if your hip pain is getting worse for no apparent reason. To learn more about
Is there a cure for hip dysplasia?
Sooner or later, most people with hip dysplasia need surgery to build better support for the hip. In the early stages of arthritis from hip dysplasia, some of the cartilage surface may be intact and hip preservation surgery is possible to re-align the joint. Re-aligning the joint allows the remaining joint surface to be in a better position for weight-bearing. Doctors often compare the joint surface to the tread on a tire that wears down with use. When the tire is out of balance, the tread will wear out faster. Sometimes the tire tread has uneven wear with large areas intact. If the tires are rotated before the tire wears out completely, then the remaining tread is in a better position to last longer. To learn more about .
After the joint surface is completely worn out, then total hip replacement is the only answer and special techniques are needed to replace a dysplastic hip. To learn more about
Sometimes the abnormal shape of the joint leads to tears in the soft rim of the socket because of instability. This rim is called the labrum and a torn labrum can sometimes be repaired by arthroscopic surgery. Athletes with trauma causing a torn labrum often benefit from arthroscopic surgery. However, arthroscopic surgery is rarely a long-term solution for hip dysplasia unless the underlying bone deformity is corrected at the same time as labral repair. To learn more about .
Are there non-surgical treatments available for adult hip dysplasia?
Unfortunately, non-surgical methods rarely provide a lasting solution for hip dysplasia because the joint itself is not properly formed. To learn more about . Some lifestyle changes can be made to preserve the life of the hip joint. Using a cane, or losing weight are the best ways to decrease the pressure on your hip joint, and a little weight loss can make big difference.
Continue to Adult Diagnosis and Symptoms “