Anatomy
The hip joint consists of the acetabulum and the femoral head (caput femoris). Attached to the femoral neck (collum femoris), on the edge of the acetabulum is a small strip of cartilage (labrum, ‘meniscus’).
Cause
In congenital hip dysplasia, the acetabulum is too small and does not cover the entire articular head, which is seen in approximately 1% of newborns who are routinely screened for hip dysplasia. Dysplasia increases stress and the risk of labrum and cartilage damage in the hip, which can result in symptoms, risk of hip dislocation and osteoarthritis.
The decreased stability of the hip joint contributes to muscle tendon-related pain among patients with hip dysplasia (Jacobsen JS et al., 2017).
The cause of dysplasia is unknown, but some heredity is involved. Girls are affected 6 times more often than boys. Up to 40% have dysplasia in both hips.
Symptoms
Fatigue, soreness and later pain around the hip with a limp. The pain is often localised to the groin and on the outer (lateral) side of the hip and is provoked by physical activity (walking and running). Clicking sensation in the hip is frequent.
Examination
If there are symptoms from the hip that suggest dysplasia, a medical examination should be performed to indicate a pelvic X-ray, which will provide the diagnosis.
Treatment
Treatment is carried out by paediatric orthopaedic surgeons. Most children with hip dysplasia can be treated with exercise without surgery, as exercise can be an alternative to surgery. However, the effect of training has so far only been studied to a limited extent, but larger studies are ongoing.
Adults with severe changes and symptoms usually undergo surgery (Ganz surgery). With early treatment, the hip usually develops normally.
After Ganz surgery, it is often difficult/impossible to return to hip-loading sports activities, but many other training options exist. Late diagnosis and treatment increases the risk of osteoarthritic changes in the hip.
Rehabilitation
As it is often not possible to return to hip-straining sports, it is important to find other sports that can be done without triggering hip pain, such as cycling, swimming etc.
Complications
Prognosis depends on the severity and timing of hip dysplasia treatment. If there is no progress or symptoms increase with non-operative treatment, it may be necessary to reassess the dysplasia and the indication for surgery. Naturally, you must consider whether the dysplasia explains the symptoms or whether the symptoms may be triggered by e.g.
