Adult Dysplasia of the Hip

What is hip dysplasia?

The hip is a ball-and-socket joint, consisting of the femoral head (the “ball”) and the acetabulum (the socket). In a healthy hip, the acetabulum adequately covers the femoral head, so that the load is distributed evenly over a large surface and the joint is stable.

In dysplasia, the acetabulum is shallow or poorly oriented, so that it does not properly “embrace” the femoral head. As a result, the load is concentrated on a smaller surface — often at the rim of the acetabulum — which becomes overloaded. This abnormal distribution of forces places excessive strain on the articular cartilage and the labrum, leading progressively to a labral tear, cartilage wear and, ultimately, osteoarthritis.

Developmental dysplasia and adult dysplasia

Hip dysplasia has its roots in development. In infants, developmental dysplasia is now screened for systematically from birth, with clinical examination and, where necessary, ultrasound. Early diagnosis in infancy allows treatment by simple, non-surgical means, with excellent results.

In adults, mild forms of developmental dysplasia of the hip may not have been diagnosed in childhood and may remain asymptomatic for years. Symptoms often appear in adolescence or young adulthood, as the inadequate coverage of the femoral head leads to abnormal load distribution and increased strain on the joint. Developmental dysplasia of the hip is an important and often underdiagnosed cause of hip pain in young adults.

Causes and risk factors

The exact cause is not always known; however, certain factors associated with an increased risk have been identified:

• A family history of dysplasia or early arthritis of the hip
• Female sex (dysplasia is clearly more common in females)
• Breech presentation during pregnancy or delivery
• Being a first-born child and restricted space in the womb

Clinical picture – Symptoms

In adults, dysplasia may remain asymptomatic for years. When symptoms do appear, the most characteristic are:

• Pain in the groin or on the side of the hip, which worsens with activity, prolonged walking or standing.
• A feeling of fatigue or “heaviness” in the hip after activity.
• A feeling of instability of the joint.
• “Clicking”, “catching” or locking, especially when there is an associated labral tear, which is common in dysplasia.
• A limp in more advanced cases.

The pain of dysplasia in a young, active adult is often underestimated. However, persistent hip pain in young people should not be ignored.

Diagnosis

The diagnosis is based on clinical examination and imaging. Radiographs (X-rays) are the main tool: with specific measurements (coverage angles), the degree of coverage of the femoral head is assessed and dysplasia is confirmed. MRI — ideally with intra-articular injection of contrast — shows lesions of the labrum and the articular cartilage, while CT provides a detailed three-dimensional picture of the bony anatomy for planning the operation.

How dysplasia leads to early arthritis

Understanding the mechanism helps to make clear why early treatment is so important. In a normal hip, body weight is distributed evenly over a large surface of the joint. In the dysplastic hip, the same force is concentrated on a much smaller surface — often at the rim of the acetabulum — so that the pressure per unit area is many times greater.

This chronic overload “wears out” the articular cartilage much faster than normal, like a tyre which, because of poor alignment, wears unevenly and prematurely. This explains why arthritis in patients with dysplasia may appear decades earlier. Correcting the dysplasia — while the cartilage is still healthy — restores the proper distribution of load and interrupts this mechanism of accelerated wear.

The relationship between dysplasia and labral tears

Dysplasia and labral tears are closely linked. In a dysplastic hip, the labrum — the fibrous ring of tissue that surrounds the acetabulum — is called upon to bear additional load, as it tries to compensate for the inadequate bony coverage and to stabilise the joint. This chronic overload often leads to a labral tear, which causes pain and a “clicking” sensation.

In a patient with dysplasia, treating the labral tear alone — without correcting the underlying dysplasia — is often not enough, as the cause (the inadequate coverage) remains. That is why a comprehensive assessment by a specialist is decisive.

Treatment

The treatment of dysplasia in adults depends on its severity, the patient’s age, the intensity of the symptoms and, above all, the condition of the articular cartilage (whether arthritis has already developed).

Conservative treatment

In mild cases or in the early stages, treatment may be conservative, with activity modification, physiotherapy to strengthen the muscles that stabilise the hip, weight control and anti-inflammatory medication. Conservative treatment relieves the symptoms but does not correct the underlying anatomical abnormality.

Surgical treatment

When the dysplasia is significant and the symptoms persist, surgical treatment is the indicated solution. The choice depends mainly on whether arthritis has already developed:

• Periacetabular osteotomy: In younger patients with dysplasia but without advanced arthritis, this operation reshapes and reorients the acetabulum so that it covers the femoral head properly. It restores the normal distribution of load and protects the joint — it is a joint-preserving operation.
• Total hip replacement: When dysplasia has already led to advanced arthritis, replacement of the joint is the definitive solution. Hip replacement in a dysplastic hip is technically more demanding, because of the altered anatomy, and Dr. Tsarouhas performs it with the ASI method and his related expertise.

Why early treatment is important

Dysplasia is a typical example of a condition in which early diagnosis matters. While the articular cartilage is still healthy, a joint-preserving operation can correct the underlying anatomical abnormality and protect the joint for decades. By contrast, if dysplasia remains undiagnosed and the wear progresses, the only remaining solution is hip replacement. For this reason, persistent hip pain in young patients — especially those with a family history — should always be investigated.

Cost of treatment

The cost varies considerably depending on the type of treatment (conservative, osteotomy or hip replacement), the materials, the hospital and the class of room, as well as the insurance cover. In most cases of surgical treatment, private insurance policies and insurance funds cover a significant part of the expense.

Precise information is given on an individual basis, after the clinical assessment. The practice is at your disposal for any relevant information.

More on the factors that determine the cost and on cover by insurance funds: Cost of surgery.

The importance of an individualised approach

Hip dysplasia is not a single condition — it covers a broad spectrum, from mild forms that barely cause symptoms to severe ones that have already led to arthritis. Accordingly, treatment is fully individualised: the same patient, at a different age or stage, may need an entirely different approach.

This makes a detailed evaluation by a specialist — with correct staging and assessment of the condition of the cartilage — decisive for the right treatment decision, so that the appropriate method is chosen at the right time.

Before and after treatment

Before treatment, the patient with symptomatic dysplasia — often a young, active person — lives with pain in the groin or on the side of the hip, a feeling of instability and limitation of their activities, while the underlying anatomical abnormality “silently” continues to wear the joint.

After the right treatment — whether a joint-preserving operation at an early stage or hip replacement for advanced wear — the patient regains pain-free movement and, in the case of joint-preserving operations, protects the joint for the future. The difference that early diagnosis makes is, here, particularly great.

Frequently asked questions

What is hip dysplasia in simple terms?

It is a developmental variation in which the acetabulum does not adequately cover the femoral head, leading to uneven distribution of load and, over time, to early wear and arthritis of the hip.

Why do symptoms appear in young adulthood?

Some mild forms are not diagnosed in childhood and remain “silent”. Symptoms appear when the chronic overload begins to cause damage, often in adolescence or young adulthood.

Is surgery always needed?

No. In mild cases or in the early stages, treatment may be conservative. Surgery is recommended when the dysplasia is significant and the symptoms persist.

What is periacetabular osteotomy?

It is a joint-preserving operation in which the acetabulum is reshaped and reoriented so that it covers the femoral head properly. It is indicated in younger patients with dysplasia without advanced arthritis.

Why is early diagnosis important?

Because, while the cartilage is still healthy, a joint-preserving operation can correct the underlying cause and protect the hip for decades. If the wear progresses, the only solution is hip replacement.

Is the cost covered by insurance?

In most cases of surgical treatment, private insurance policies and insurance funds cover part or all of the expense. The practice can give you detailed information.

Can I play sport with hip dysplasia?

Many patients with dysplasia are active or athletes. Whether sport is possible depends on the severity and the symptoms. The right treatment can allow an active life to continue while protecting the joint.