Understanding Hip Dysplasia: Symptoms, Surgical Interventions, and the Role of Physical Therapy

Hip dysplasia is a common orthopedic condition affecting people of all ages. It occurs when the hip joint doesn't develop properly, leading to various symptoms and discomfort. While more severe cases of hip dysplasia may require surgical intervention, physical therapy can often be instrumental in managing pain and increasing mobility. Our team of mobility experts at EW Motion Therapy can assess your movement and develop an individualized treatment plan addressing your needs and goals. But even if you decide that our physical therapy doesn’t fit your needs, you can still read on as we explore what hip dysplasia is, its symptoms, surgical interventions, and physical therapy’s crucial role in pre and post-surgery recovery. 

What is hip dysplasia?

Hip dysplasia, also known as developmental dysplasia of the hip (DDH), is a condition where the hip joint doesn't form correctly during early childhood, resulting in a shallow hip socket that doesn't fully cover the ball of the thigh bone (femoral head). As a result, the hip joint may become unstable, leading to various issues and discomfort.

Symptoms of hip dysplasia

1. Hip instability: Patients with hip dysplasia often experience a sense of instability in their hip joint. This instability can lead to frequent dislocations or subluxations, where the femoral head partially slips out of the hip socket.
2. Pain and discomfort: Hip dysplasia can cause pain, especially in the groin area or the side of the hip. This discomfort may vary in intensity from mild to severe.
3. Limited range of motion: Patients may notice a reduced range of motion in their affected hip. Simple tasks like bending, sitting, or walking may become challenging.
4. Uneven leg length: Hip dysplasia can make one leg shorter, leading to a noticeable limp.
5. Clicking or popping sensation: Some individuals with hip dysplasia report hearing or feeling a clicking or popping sensation in their hip when they move. 

How does age affect treating hip dysplasia?

The patient’s age plays a significant role in determining the most appropriate treatment approach for hip dysplasia. The treatment strategy for hip dysplasia can vary widely depending on the patient's age and developmental stage. Let's explore how age influences the treatment of hip dysplasia across different life stages:

Infants and babies (0-2 years old)

1. Pavlik harness: In infants diagnosed with hip dysplasia, especially during the first few months of life, a Pavlik harness may be used. This soft brace helps hold the baby's hips in a proper position, allowing the hip joint to develop normally. Regular monitoring by a pediatric orthopedic specialist is essential to ensure the harness is adjusted correctly.
2. Ultrasound monitoring: Infants often receive regular ultrasound examinations to assess the progress of the hip joint's development. If the hip joint stabilizes and develops normally, further treatment may not be necessary.

Children (2-6 years old) 

1. Closed reduction: In some cases where hip dysplasia is detected in early childhood, a closed reduction procedure may be performed, which involves manually repositioning the hip joint and placing the child in a spica cast to maintain the correct hip position during the healing process.

Children and adolescents (6-18 years old)

1. Bracing: Children and adolescents with mild to moderate hip dysplasia may be prescribed bracing, which can help improve hip joint stability and encourage proper development.
2. Physical therapy: Physical therapy is often recommended, depending on the individual’s age and specific needs, to improve muscle strength, range of motion, and overall hip joint function. Exercises and interventions can help manage symptoms and prevent further complications.

Young adults (18-30 years old)

1. Periacetabular osteotomy (PAO): PAO is a surgical option for young adults with persistent hip dysplasia that causes pain or instability. This procedure involves repositioning the hip socket to provide better coverage for the femoral head. It is most effective when hip dysplasia is detected and treated early.
2. Hip arthroscopy: In some cases, minimally invasive hip arthroscopy may address structural issues within the hip joint.

Adults (30 years and older)

1. Total hip replacement (THR): In severe cases of hip dysplasia, particularly in adults, total hip replacement may be necessary. This procedure involves replacing the damaged hip joint with an artificial implant.
2. Conservative management: Older adults with hip dysplasia may opt for non-surgical approaches to manage symptoms, such as pain medication, physical therapy, and lifestyle modifications to reduce stress on the hip joint.

Seniors (65+ years old)

1. Total hip replacement (THR): THR is often the preferred treatment option for seniors with hip dysplasia experiencing significant pain and mobility issues to restore mobility and improve quality of life.

It's important to note that the effectiveness of treatment can vary based on the patient's age and the severity of hip dysplasia. Early diagnosis and intervention are crucial for achieving the best outcomes, especially in infants and young children. Regular follow-up with orthopedic specialists and adherence to treatment recommendations are key to managing hip dysplasia effectively at any age.

The treatment of hip dysplasia is influenced by the patient's age and the stage at which the condition is diagnosed. The goal is to achieve proper hip joint development, alleviate pain, and improve function. Depending on the individual’s age and specific needs, the treatment approach may range from non-surgical interventions to surgical procedures. 

How can physical therapy help manage mild cases of hip dysplasia?

Physical therapy plays a crucial role in managing mild cases of hip dysplasia by addressing pain, improving hip joint stability, enhancing muscle strength, and increasing the range of motion. Here's how physical therapy can help individuals with mild hip dysplasia:

1. Pain management: Many people with mild hip dysplasia experience discomfort and pain in the hip area. Physical therapists can employ various techniques to manage pain effectively, such as
   1. Manual therapy: Hands-on techniques like joint mobilization and soft tissue massage can help relieve muscle tension and reduce pain.
   2. Modalities: Heat, ice, ultrasound, or electrical stimulation can relieve pain and reduce inflammation.
2. Strengthening exercises: Strengthening the muscles around the hip joint is essential for providing better support and stability to the joint. Physical therapists design tailored exercise programs that focus on strengthening the hip muscles, including the glutes, hip flexors, and adductors. These exercises can include:
   1. Clamshells: Lying on your side with knees bent and feet together, lift the top knee while keeping your feet touching.
   2. Bridges: Lying on your back with knees bent, lift your hips off the ground.
   3. Leg raises: Lying on your side, lift the top leg while keeping it straight.
3. Range of motion exercises: Individuals with hip dysplasia often have limited hip joint mobility. Physical therapists can guide patients through exercises that aim to improve the range of motion in the hip joint. These exercises may include:
   1. Hip flexor stretches: To stretch the muscles at the front of the hip.
   2. Hip rotations: Gentle movements to increase hip joint flexibility.
4. Posture and body mechanics education: Physical therapists can educate patients on proper body mechanics and posture. This knowledge helps individuals avoid movements and positions that can exacerbate hip pain and discomfort.
5. Core strengthening: A strong core provides stability to the entire body, including the hip region. Physical therapists often include core-strengthening exercises in the treatment plan to enhance overall stability.
6. Functional training: Physical therapists work with patients to improve their ability to perform everyday activities without pain or discomfort. This may include practicing walking, climbing stairs, and getting in and out of a chair with proper form.
7. Home exercise programs: To complement in-office sessions, physical therapists provide patients with customized home exercise programs. Consistent adherence to these exercises can significantly contribute to managing hip dysplasia symptoms.
8. Monitoring progress: Physical therapists closely monitor the patient's progress and adjust the treatment plan as needed. They can also provide guidance on when to progress to more challenging exercises.
9. Pain relief techniques: Physical therapists can teach patients self-care techniques to manage pain independently. This may include using heat or ice packs and performing gentle stretches at home.
10. Patient education: Understanding the condition and its management is crucial. Physical therapists educate patients about hip dysplasia, its causes, and the importance of ongoing exercises and self-care.

It's important to note that the effectiveness of physical therapy in managing mild hip dysplasia can vary from person to person. The success of the treatment depends on factors like the severity of the condition, the individual's commitment to the prescribed exercises, and their overall health.

Physical therapy is an integral part of managing mild cases of hip dysplasia. It aims to reduce pain, enhance hip joint stability, improve muscle strength, and increase range of motion. By following a tailored physical therapy program and incorporating the exercises and techniques into daily life, individuals with mild hip dysplasia can experience improved mobility and a higher quality of life.

Surgical interventions for hip dysplasia

While mild cases of hip dysplasia can sometimes be managed with non-surgical interventions like bracing or physical therapy, more severe cases often require surgical treatment. Here are some common surgical interventions for hip dysplasia:

1. Hip arthroscopy: In this minimally invasive procedure, a surgeon uses small incisions and a camera to visualize and repair the hip joint. It's often used for early-stage hip dysplasia to correct minor abnormalities.
2. Open reduction and hip preservation surgery involves making a larger incision and repositioning the femoral head within the hip socket. The surgeon may also reshape the hip socket to improve its femoral head coverage. This procedure is suitable for moderate to severe cases.
3. Periacetabular osteotomy (PAO): PAO is a major surgical procedure where the surgeon cuts and repositions the hip socket to provide better femoral head coverage. It's often recommended for young adults with hip dysplasia.
4. Total hip replacement (THR): A total hip replacement may be necessary in severe cases where the hip joint is significantly damaged. The damaged hip joint is removed and replaced with an artificial implant during this surgery.

Pre and post-op physical therapy for hip dysplasia 

Physical therapy is a crucial component of pre- and post-surgical care for individuals with hip dysplasia. Here's how physical therapy can help:

Pre-surgery physical therapy

1. Pain management: Physical therapists can teach pain-relief techniques and exercises to alleviate discomfort and improve the patient's overall quality of life before surgery.
2. Strengthening: Strengthening the muscles around the hip joint can help provide better stability and support to the joint, which can be especially beneficial for individuals with hip dysplasia.
3. Range of motion exercises: Physical therapists can work with patients to improve their hip joint's range of motion, making everyday activities more manageable and reducing the risk of complications after surgery.
4. Education: Patients can learn about their condition, understand the surgical process, and set realistic expectations for their recovery.

Post-surgery physical therapy

1. Rehabilitation: Physical therapists play a vital role in the patient’s rehabilitation after surgery. They design customized exercise programs to help patients regain strength and mobility gradually.
2. Pain management: Physical therapists can use various techniques, such as manual therapy and modalities like ice or heat, to manage post-surgery pain effectively.
3. Gait training: Learning to walk properly after hip surgery is essential. Physical therapists can assist patients in relearning how to walk with proper form to prevent long-term complications.
4. Functional training: Patients will work on specific functional movements and activities to help them return to their daily routines and regain independence.
5. Monitoring progress: Physical therapists closely monitor the patient's progress, adjusting their treatment plan to ensure a successful recovery.

Incorporating physical therapy into the treatment plan for hip dysplasia can significantly improve outcomes and the patient's overall well-being.

Hip dysplasia is a condition that can significantly impact an individual's life, causing pain, discomfort, and limitations in daily activities. However, with the right combination of surgical interventions and physical therapy, patients can regain mobility, reduce pain, and enjoy an improved quality of life.

If you or someone you know is dealing with hip dysplasia, seeking medical advice and exploring treatment options is crucial. Remember that early diagnosis and intervention can lead to more successful outcomes. Whether through minimally invasive procedures, open surgeries, or physical therapy, there are ways to manage hip dysplasia and help individuals lead healthier, more active lives. Your primary care provider or surgeon can help you decide if physical therapy is your best treatment option. We consider it a privilege at EW Motion Therapy to help our clients reduce pain and return to their favorite activities. If you’re curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently asked questions.