Hip dysplasia (also known as clicky hips) is a congenital condition where the hip joint forms improperly during foetal development. The ball of the thigh bone (femur) may sit outside the hip socket, causing the joint to be too loose and prone to dislocation. This condition can affect one or both hips and may lead to significant pain and arthritis at a young age.
Developmental dysplasia of the hip (DDH) is often initially identified by a paediatrician shortly after birth. However, it can remain undetected until the affected individual begins to experience pain. This can result in detection occurring as late as the teenage years or even early adulthood.
Hip dysplasia may cause pain in the hip area and result in a limp or leg length discrepancy. Patients may feel that one leg is shorter than the other, and the foot might point outward. Symptoms can vary and might not be evident at birth, leading to potential detection at later stages, including the teenage years or early adulthood. Left untreated, hip dysplasia can lead to painful osteoarthritis, often necessitating a hip replacement.
Recognising hip dysplasia:
Hip dysplasia doesn’t always come with obvious outward signs. However, it’s important to be vigilant and seek medical assessment if you or your child experience:
Hip dysplasia is typically developmental and can affect one or both hips. Nonetheless, it often demonstrates a predilection for the left hip and exhibits a higher frequency in females, firstborn children, babies born in the breech position, as well as those with a family history of the condition.
During young adulthood, childhood Developmental Dysplasia of the Hip (DDH) can develop into adolescent hip dysplasia if it hasn’t been diagnosed or treated during childhood. Despite the severity of the condition, it can occasionally go unnoticed during childhood and may not manifest any visible symptoms until later in life.
The detection of hip dysplasia in older adults is similar to that in younger individuals. While hip dysplasia can be present at birth, symptoms may not emerge until adulthood. If left untreated, it can progress to painful osteoarthritis and necessitate hip replacement surgery.
Treatment methods vary based on the patient’s age and the severity of the condition.
A Pavlik harness, a specialised positioning device, can be used to keep the thigh bone in place and promote proper hip development. Crafted for this purpose, the harness enables unrestricted leg movement and convenient nappy changes without the need to repeatedly undo buckles or straps. This thoughtfully designed support stabilises the hip and aids in tightening ligaments that could have become lax since birth.
1 to 6 months
Straps or similar devices may be used to reposition the baby’s thigh bone. This method is generally effective, even if the child’s hip was initially dislocated. The duration for which these straps or braces are required varies; they might need to be worn full-time for a minimum of six weeks, followed by part-time usage for an additional six weeks if necessary. If the baby’s hips struggle to remain in position after strapping, a more rigid abduction brace might be recommended. This type of brace helps prevent leg movement, ensuring that the hip stays in place.
In certain cases, a closed reduction procedure might be necessary. During this procedure, your child’s thighbone will be carefully repositioned by a doctor. An external device will be used to provide support while the area heals, a process that typically takes between 3 and 6 weeks, depending on individual healing rates.
6 months to 2 years
Older babies are also treated with closed reduction and spica casting. Skin traction could be used before bone repositioning to ensure muscles are adequately stretched. This step helps create the necessary space for proper hip alignment. This procedure can be done at home or in the hospital.
When non-surgical approaches don’t provide the desired results, surgical interventions become necessary. The choice of surgery depends on factors such as age, severity of joint damage, and the extent of hip displacement. Some of the surgical options available for treating hip dysplasia are detailed below.
6 months to 2 years
For children between 6 months and 2 years, open surgery is performed if the closed reduction procedure is unsuccessful in repositioning the thighbone. This surgical procedure involves making an incision to access the hip joint and adjust bones and tissues. Occasionally, a leg bone might need to be reshaped or shortened, followed by the application of a stabilising spica cast. This is achieved through surgery, during which X-rays are taken to ensure accurate positioning. Following the surgery, a spica cast is applied to maintain joint stability during the healing process.
Children older than two years
As children grow and become more active, hip looseness can worsen over time. In cases where hip dysplasia has progressed to the point where the hip joint becomes significantly loose and prone to dislocation during movement or sitting, open surgery becomes necessary. This surgical intervention aims to realign the hip joint to restore stability. Following the surgery, a spica cast is typically applied for a minimum of 6 weeks. This cast helps prevent the recurrence of dislocations and allows the joint to heal properly.
Younger adults (up to 40 years old)
Periacetabular Osteotomy (PAO) is a surgical procedure that focuses on preserving and enhancing the patient’s natural hip joint rather than resorting to artificial joint replacement. This surgery works to alleviate pain, restore function, and maximise the mobility and function of the dysplastic hip.
This procedure involves making carefully planned cuts in the pelvic bone around the hip socket. These cuts allow the surgeon to reposition the socket itself, correcting its alignment and improving the stability of the hip joint.
The approach to treating hip dysplasia in adults is highly individualised and depends on factors such as age, the extent of joint surface deterioration, and the degree of hip displacement from the socket. In general, many individuals who experience hip dysplasia may require surgery to enhance hip stability.
A useful analogy is to compare the joint to the tread on a tyre. If the wear is uneven, the tyre deteriorates quickly. However, with timely intervention, the remaining tread can be better preserved.
During the early stages of dysplasia-induced arthritis, some portions of the cartilage might still be intact. In such cases, hip preservation surgery can be used to adjust the joint. By repositioning the joint, the remaining cartilage can better withstand weight-bearing forces.
When the cartilage on the joint surface is significantly degraded and worn away, total hip replacement becomes the most viable solution. However, hip dysplasia increases the complexity of hip replacement surgery due to the unique structural challenges it presents. This requires specialised surgical techniques tailored to the replacement of a dysplastic hip. Professor Munjed Al Muderis brings extensive experience and expertise in performing total hip replacements for patients with hip dysplasia, ensuring optimal outcomes.
To learn more about the hip replacement procedure, as well as what you can expect prior to, during, and after the surgery, please visit our Hip Replacement page.