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The hip joint is comprised of the thigh bone (femur) and the pelvic bone. The upper end of the femur is shaped into a ball (femoral head) that fits into a socket (acetabulum).
In a normally developed hip, the round ball will sit comfortably inside of the hip socket. In a child with hip dysplasia, the ball is loose in the hip socket, which means the hip is dislocated. This condition presents itself in children who have previously had developmental hip dysplasia.
Learn about the difference between hip dysplasia and developmental hip dysplasia (DDH) in infants. The severity of hip dysplasia and the age of the patient will determine the course of treatment. The goal of treatment is to maintain the contact of the femoral head (ball) and the acetabulum (socket) decrease pain and preserve the patient’s native hip.
The actual causes of hip dysplasia are still unknown; however, it seems that hip dysplasia is a developmental problem. It can occur before birth, after birth and less often during infancy. Children with hip dysplasia have had developmental hip dysplasia which may or may not have been treated during infancy or toddler years.
There are several recognized risk factors for hip dysplasia:
• Children who have had developmental hip dysplasia
• A family history of hip dysplasia
• Being the first-born child
• Female (versus male) gender
• Babies who are born in the breech position (head up and feet down)
The pain may start out mild, but it can increase in severity and frequency over time. The pain associated with hip dysplasia is due to an abnormal amount of pressure placed on the rim of the acetabulum (socket). This pressure on the hip socket rim can lead to cartilage damage and eventually arthritis of the hip joint.
Hip dysplasia is suspected in patients who have typical symptoms. Your doctor will need to perform a physical examination to determine how well your child's hip moves. Some tests will be done to reproduce the patient’s discomfort in the hip joint.
Imaging diagnostic tests are extremely important in diagnosing hip dysplasia. Typically, your doctor at Children’s Hospital Colorado will order an x-ray. X-rays, along with other radiographs, allow the physician to evaluate the structure of the bones that make up your hip joint: the femur (ball) and the acetabulum (socket).
Often a CT scan (computerized tomography) is necessary as well. A CT scan is a computerized compilation of many small x-rays taken at slightly different angles.
MRI (magnetic resonance imaging) is also important for the physician to be able to view the lining of the hip joint, the labrum (the cartilage on the edge of the hip) and other soft tissue structures within the hip and pelvis. An MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
The Hip Program at Children’s Hospital Colorado has orthopedic providers subspecialized to work specifically with hips. We use x-rays, CT scans and MRI to diagnose hip dysplasia in kids and adolescents.
We also have a special MRI technique called a dGEMRIC (delayed gadolinium enhanced magnetic resonance imaging of the cartilage), which gives your child's doctor a more accurate measurement of the health of the cartilage in the hip because it is important to understand if the cartilage is damaged and the extent of the damage.
X-rays are taken during the clinic visit, and CT and MRI scans are performed in the radiology department. The CT scans take approximately 30 minutes to complete. The MRI done on patients 6 years and oler is typically not a sedated procedure and lasts approximately 45 minutes to one hour. The dGEMRIC MRI requires IV placement of contrast before the scan can be done. Feel free to bring a movie or music for your child, and wear comfy clothes when coming to have an MRI done.
Our providers are able to diagnose hip dysplasia based on your child's medical history, findings from the physical examination and results of the ordered imaging studies.
The severity of hip dysplasia and the age of the patient will determine the course of treatment. The goal of treatment is to maintain the contact of the femoral head (ball) and the acetabulum (socket), and to decrease pain and preserve the patient’s hip.
There are several ways to treat hip dysplasia. In mild cases of hip dysplasia, conservative therapy with medication and physical therapy is the may be the first step in treatment. If conservative therapy does not provide pain relief, then you and your provider can explore the idea of surgical intervention.
Oral pain medications can be taken to help relieve the pain and decrease inflammation in the hip. Although medication may help, it is only temporary, and cannot correct hip dysplasia.
Physical therapy/activity modification
Core-strengthening physical therapy and activity modification can help improve the symptoms of hip pain secondary to hip dysplasia. This can help decrease the pain caused by hip dysplasia, but will not correct the lack of coverage of the hip socket is providing to the ball at the end of the thigh bone.
An injection with a combination of an anesthetic (numbing medication) and a corticoid steroid may be recommended to alleviate the pain and inflammation surrounding the hip joint. A hip injection may also be ordered to determine that the hip pain is indeed coming from the hip joint.
One of the treatment options for hip dysplasia in a patient who is age 12 or older is a procedure called periacetabular osteotomy, or a PAO. This orthopedic surgery involves opening up the pelvis and carefully making 4 cuts in the pelvis bone to rotate the acetabulum. Goals of the surgery are to reorient the acetabulum to provide better coverage of the femoral head and to lessen the abnormal forces on the rim of the acetabulum.
A patient’s pain can be alleviated once the amount of pressure that is placed on the acetabular rim is minimized. Another goal of this surgery is to preserve the hip joint and decrease the chance of a patient developing arthritis.
By working together as a team, we are able to develop a comprehensive approach to diagnose and treat hip dysplasia. Specialists from our Hip Program offer a broad spectrum of treatment options and extend to include experts in the fields of rehabilitation, physical therapy, rheumatology, anesthesiology and pain.
With a sole focus on hip disease in young patients, our Hip Program is nationally recognized for excellence in hip surgeries, and our doctors educate healthcare providers around the nation on hip diseases and surgery. Our goal is to provide our patients with options for pain control, function improvement and preservation of the hip joint.
Learn more about our Hip Program.
Physical Medicine & Rehabilitation, Physical Medicine & Rehabilitation - Pediatric