Hip dysplasia is a congenital condition resulting in malformation of the hip joint.
It may affect one or both hips, and causes misalignment between the femoral head and the hip socket, resulting in pain, arthritis and risk of dislocation.
Developmental Dysplasia of the Hip (DDH) is commonly identified shortly after birth, but may be disagnosed as late as early adulthood.
Symptoms of DDH can include uneven leg length, restricted range of motion and a clicking or ‘popping’ sound associated with hip movement. Developmentally, it can cause delays in walking, or a waddling or swaying gait.
Pain is not common among the very young, but can manifest in later childhood in the hip, groin and buttocks. Left untreated, DDH can contribute to the development of osteoarthritis.
DDH results from a combination of genetic and environmental factors.
A family history of the condition, and certain genetic traits, can increase the chance of developing the condition, as can conditions in the womb during pregnancy and the hormones to which the baby is exposed.
Holding or wrapping a newborn in a way that restricts their hip movement can also contribute to DDH.
Non-surgical treatment options can vary according to age and symptom severity. These include:
Harnessing: up to the age of approximately 6 months, a Pavlik harness can be used to encourage proper alignment of the femoral head within the hip socket.
Bracing or splinting: for slightly older infants (6-12 months), a more rigid brace, or an abduction splint, may be used to stabilise the hips.
Closed reduction and casting: for children older than 6 months, or those younger for whom bracing is ineffective, it may be possible to complete a manual repositioning (closed reduction) of the hips under anaesthesia. The hips will then be held by a cast for several months during healing.
In adults, non-surgical treatments typically focus on symptom management, and include:
Physical therapy: targeting improved hip strength and renge of motion, as well as improvements in posture and gait intended to minimise joint damage.
Lifestyle modification: these can include avoiding activities which risk further damage to the hip joint, and reducing bodyweight to reduce the stress placed on it.
If non-surgical interventions ultimately prove unsuccessful, there are additional surgical options available to address the symptoms of hip dysplasia. These include:
Open reduction: this involves gaining direct access to the hip joint via incision in order to manipulate the femoral head into the hip socket.
Osteotomy: involves the cutting and modification of either the femur or the pelvic bone to improve the position of the femur within the hip socket or the its relative alignment. A more advanced procedure, triple pelvic osteotomy, involves the cutting of the pelvis at three points to improve the socket coverage of the femoral head. This requires the hip to be fixed with screws or plates following positioning.
Hip arthroscopy: arthroscopic surgery can be used to access and repair damaged tissue or debris within the hip joint.
Hip resurfacing: commonly used in younger adults where there is a desire to preserve more of the original bone, this involves capping the femoral head with a metal implant.
Hip arthoplasty (total hip replacement): used in cases of significant hip damage in adults and the elderly, this involves the total removal of the hip joint and its replacement with a prosthetic.
Where the hip is very severely damaged, the decision may be taken to complete an arthrodesis (hip fusion), where the femur and the pelvis are fused together. This can relieve pain, but eliminates movement at the hip joint and is typically carried out as a ‘last resort’.
To learn more about hip replacement, and what to expect from hip replacement surgery, please visit our Hip Replacement page.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.