Hip Dysplasia in Adolescents and Young Adults | Diagnosis and Treatments

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How is hip dysplasia diagnosed?

Boston Children’s orthopedic team uses a variety of tests to diagnose hip dysplasia.

The first step is a thorough patient history and physical exam. During the exam, the physician checks the range of motion to determine any limitations. If your infant is diagnosed with hip dysplasia during the first few months of life, her doctor will order an ultrasound exam to evaluate her hips.

For children, adolescents and young adults with hip dysplasia imaging studies may be ordered, including x-ray, MRI or a CT scan, to confirm the diagnosis of hip dysplasia. Boston Children’s hip preservation team developed a special MRI technique to detect any early arthritis caused by hip dysplasia or other hip abnormalities. The technique — called “dGEMRIC” (delayed gadolinium-enhanced MRI of cartilage) — is often recommended for patients with hip dysplasia.

Sometimes, an ultrasound-guided diagnostic injection will be recommended to confirm the location of hip pain.

How is hip dysplasia treated?

At Boston Children’s, our hip dysplasia treatment goal is to preserve the hip joint as long as possible. Our hip specialists provide a variety of treatment options for adolescents and young adults with hip dysplasia.

Hip dysplasia non-surgical treatment

Non-surgical treatment — which includes steroid injections, anti-inflammatory medication and physical therapy — may be appropriate for patients with very mild cases of hip dysplasia.

Patients with very severe hip dysplasia whose joints have been significantly damaged and whose only treatment option is hip replacement may opt for non-surgical treatment as an interim step prior to hip replacement.

Hip dysplasia surgical treatment

Periacetabular osteotomy (PAO) is the main surgical treatment for adolescents and young adults with hip dysplasia who experience pain and have limited cartilage damage.

The goals of PAO are to:

  • reduce or eliminate pain
  • restore function
  • maximize the function of the patient’s hip

In this procedure, the surgeon makes a series of cuts to rotate the socket into proper position and inserts metal screws to hold it in place. These screws are usually removed in an outpatient procedure four to 12 months after PAO surgery. PAO may serve as a lifelong treatment if performed before hip arthritis progresses.

PAO may be combined with hip arthroscopy to treat the labral tear (a tear in the cartilage surrounding the hip joint) that occurs in some patients with hip dysplasia. In this minimally invasive operation, the surgeon works inside the joint to repair the tear.

Hip dysplasia recovery and long-term outlook

Physical therapy usually begins the day after surgery and starts with range-of-motion exercises. The physical therapist assists the patient with walking in parallel bars and then with crutches. Patients are discharged with a home exercise program. Strength returns gradually after surgery. Most patients need to use crutches for three months after PAO.

After the PAO has healed, we encourage patients to return to the highest level of reasonable activity that the hip joint allows. However, overuse injuries can occur. Pounding activities like running may be discouraged.

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- Sandra L. Fenwick, President and CEO

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