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Hip Dysplasia: How Physiotherapy Can Help

Hip Dysplasia: How Physiotherapy Can Help
16 February 2022 PhysioCentral

Concerned about hip dysplasia for yourself or your child? You’re not alone. Hip dysplasia, in which the bones in a person’s hip joint are not properly developed, may be affecting a lot more people than previously thought, according to a recent Hong Kong study. Approximately 1 in 1000 babies screened for hip dysplasia in the first months of life are identified to present with this condition. However, hip dysplasia that either starts in adulthood or lingers from childhood has recently been found to affect 17.2% of people that presented for an x-ray due to undiagnosed hip pain at Princess Margaret Hospital in Hong Kong over a one year period.

While hip dysplasia can lead to serious consequences like pain, decreased function, and hip osteoarthritis if left untreated, once diagnosed, most people can resume healthy and active lives with appropriate treatment and physical therapy care. Here’s what you should know about hip dysplasia, how to recognise it, and how our physiotherapists can help you manage it so you can keep doing the things you love.

What Causes Hip Dysplasia?

In hip dysplasia, the ball-and-socket joint where the top of the thigh bone (femur) attaches to a curved socket in the pelvis either doesn’t line up normally or the socket itself isn’t quite deep enough to effectively hold the top of the thigh bone in place. This makes the joint unstable, and this instability progresses to a range of painful consequences to the hip joint and the surrounding tissues over time. There are two primary types of hip dysplasia we see:

Development hip dysplasia – often diagnosed within the first three months to one year of life and describes a range of abnormalities affecting the hip joint which may include the shape, size and orientation of the head of the femur, the acetabulum (hip socket) or both
Acetabular hip dysplasia – hip dysplasia that occurs when the acetabulum is shallow and so doesn’t sufficiently cover the head of the femur in the hip joint. This causes the hip joint to be unstable. Acetabular hip dysplasia is typically diagnosed in late adolescence or in adulthood

Some risk factors that have been identified for hip dysplasia include the female gender (four times more likely to have developmental hip dysplasia), babies born in or that spend significant time in the breech position in the third trimester, improper swaddling (see hip-healthy swaddling tips), limited space in the womb, and having a family history.

How To Spot Hip Dysplasia

When hip dysplasia is undiagnosed in adults, one recurring feature that our physios notice is that clients present to us with hip pain and discomfort that they often link back to being fairly inflexible for some time. For these clients, conducting a thorough examination reveals that it’s the changes to the hip joint as a result of hip dysplasia that is the problem and the cause of their pain – and the inflexibility is just a byproduct.

Other signs we look for in adults include hip or groin pain that is worsened by activity, limping, feelings of the hip catching, snapping or popping, muscle aches around the hip, feelings of instability around the hip, and sometimes the presence of night pain. As the damage progresses, the symptoms of hip dysplasia tend to worsen over time.

In kids, developmental hip dysplasia is routinely screened for by health professionals during an infant’s first year of life, who may look for asymmetrical creases on the thighs and buttocks, a hip click, a difference in leg length, a notable difference in flexibility between the hips, and limping when a child begins walking. If you’re concerned or aren’t sure if hip dysplasia has been assessed in your infant, it’s always best to have them checked as there may be no noticeable features of the condition.

Treating Hip Dysplasia

Treating hip dysplasia varies based on whether it is detected in infancy or adulthood, and as physios, we work extensively with both groups of people.

Treating hip dysplasia in infants

Treating hip dysplasia in infants will depend on its severity and the age that it’s picked up. When a baby is less than three months old or the condition is relatively mild as confirmed by x-ray, a wait-and-see approach is often taken, scheduling to re-evaluate the infant later in the year and educating parents on hip positions in swaddle and baby carrier, general positioning advice, as well as what to look out for in the coming months.

If the dysplasia is moderate or severe, a Pavlik harness or other brace may be recommended. The Pavlik harness holds the hips in an ‘M’ position and allows the legs to maintain some movement. It is worn for 23-24 hours per day, often for 8-12 weeks. The hips are periodically reassessed to monitor progress, which will ultimately determine how long the harness is worn.

If the harness does not produce sufficient results, a closed reduction procedure may be recommended, where the hip joint is gently moved into the correct position, followed by a few months in a plaster cast to keep the bones in the correct position.

We work with parents of children undergoing treatment of hip dysplasia by helping demonstrate and educate them on how to best care for their children’s hips, as well as massage, stretching and strengthening techniques that may aid hip recovery while the child is in the brace and after any surgery.

Treating hip dysplasia in adults

When hip dysplasia presents in adults, it means that the condition has likely gone undetected and undiagnosed for some time without proper treatment. Hence, the first step is to understand each person’s unique circumstances, including the shape, strength and integrity of the hip joint, the stress being placed on the joint during gait, the overall joint movement and function, and the person’s goals for future activity.

Physiotherapy rehabilitation can be of great value to those with hip dysplasia in helping modify physical activity and correct movement patterns that reduce stress on the hip joint, improve joint strength, and correct posture. Even small changes like adjusting seat height or heel height can help alter the load on the hips. In an individual case study, correcting the posture of a 31-year-old woman with hip dysplasia demonstrated significant improvements in pain, function and activity, noting significantly improved posture in walking and standing, which helped her return to recreational running and moving generally pain-free within one year.

When clinically indicated, physiotherapy rehabilitation can be performed as a first-line conservative treatment approach, or alongside a joint-retaining corrective surgery called periacetabular osteotomy (PAO). A PAO may be suitable if the dysplasia is detected before the joint degenerates from osteoarthritis. During a PAO, a series of cuts are made to the pelvis in order to reposition the acetabulum to improve alignment. It is then fixed in place by a series of screws, and new bone is formed as the hip heals. Short term outcomes after a PAO show that up to 71% of people can regain the same or higher level of physical activity after their surgery.

If rehabilitation and the PAO are unsuccessful, a total hip replacement may be indicated. Preparing for and recovering from a total hip replacement requires significant rehabilitation, gait retraining, and may require mobility aids like a cane.

Our physiotherapists can help you with:

  • Preparing your body for surgery
  • Recovering from surgery – regaining your strength, balance, coordination, flexibility and mobility
  • Bodyweight management to reduce stress from the hip joint
  • Selecting the right activities and exercise to avoid overloading the hip joint
  • Exercise modifications and techniques to use your body during sports without causing damage to the hip

We’re Here To Help

Early detection is crucial when it comes to hip dysplasia at any age. This is where our physios play a vital role through our careful and comprehensive screening protocols that diagnose hip dysplasia, as well as distinguish it from other injuries surrounding the hip or from a condition called femoroacetabular impingement (FAI), which can have similar symptoms. We can also refer you for x-ray imaging of your hip.

Book your appointment with our fantastic team by calling +852 2801.4801 or book your appointment online.

 

 

References

1. https://www.aafp.org/afp/2006/1015/p1310.html
2. https://www.hkjr.org/system/files/v23n1_34young.pdf
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143976/
4. https://www.aafp.org/afp/2006/1015/p1310.html
5. https://www.csp.org.uk/frontline/article/clinical-update-acetabular-hip-dysplasia-physios-role-0
6. https://pubmed.ncbi.nlm.nih.gov/10742378/
7. https://pubmed.ncbi.nlm.nih.gov/23145903/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410069/
9. https://pubmed.ncbi.nlm.nih.gov/24914031/