Hip Dysplasia / Often Also Called Hip Joint Dysplasia: Information & Specialists

Hip dysplasia is a malformation of the hip socket, which houses the head of the femur. Girls are affected by this malformation more often than boys. If hip dysplasia goes undiagnosed, it can lead to signs of wear and tear (osteoarthritis) or hip osteoarthritis. These can cause pain and severe difficulty walking.

Hip dysplasia can be reliably detected as early as the first few days of life using a safe ultrasound examination. Newborns are examined by orthopedic surgeons and pediatricians so that any necessary splinting treatment can begin as early as possible.

This ultrasound examination of the hip joint has proven so effective that it has been included in the mandatory U3 preventive health screening (4th–6th week of life after birth).

When hip dysplasia is detected early, the chances of a full recovery are very high. With targeted and consistent treatment, healthy hip joints can usually develop. This helps prevent

• any surgeries that might be necessary later on,
• severe hip limp, or
• premature hip degeneration

be avoided.

Hip dysplasia can be congenital or, in some cases, acquired later in life. Often, the hip socket is too small and too steeply angled. As a result, the femoral head is not sufficiently covered by the acetabulum, particularly on the sides and front, which corresponds to inadequate coverage of the femoral head.

This malformation can lead to hip dislocation. In this condition, the femoral head slips laterally upward or backward out of the too-small hip socket—a condition known as hip dislocation. Fortunately, however, the incidence of hip dislocations is significantly lower (only about 1 in 15 children with hip dysplasia has a hip dislocation).

Hip dysplasia occurs about 5 to 7 times more frequently in girls than in boys and tends to run in some families. Often, several siblings are affected.

Other possible causes of hip dysplasia:

• mechanical factors such as a multiple pregnancy or
• an unfavorable fetal position, or
• insufficient amniotic fluid during pregnancy, which leads to relatively cramped conditions for the unborn child.

Numerous accompanying neurological conditions, such as

• spina bifida or
• as a result of early-childhood brain damage (cerebral palsy), or
• as well as rare genetic disorders

can lead to hip dysplasia.

The key to successful conservative (non-surgical) treatment of hip dysplasia is

• the severity of the malformation and
• early initiation of treatment.

The more severe the dysplasia or the later in life it is diagnosed, the more likely the doctor will (have to) resort to surgical methods.

Conservative management of severe dysplasia and dislocations is based on three key pillars:

• repositioning (aligning the joint within the hip socket),
• retention (ensuring that the femoral head remains in the acetabulum) using a cast, spreader pants, or splints/bandages, and
• maturation therapy, i.e., consistent follow-up treatment with orthoses under ultrasound monitoring. This allows the joint to develop properly.

In cases of very mild dysplasia and in infants, it is usually sufficient to swaddle the child a little more widely and allow the child to move naturally.

In most cases, the children then have no further problems as they continue to develop, and their hips mature properly. This maturation of the hip sockets is also monitored by the doctor via ultrasound.

However, to avoid long-term consequences, hip dysplasia should be diagnosed as early as possible—which, since 1996 in Germany, has been ensured through ultrasound examinations during the U2 and U3 checkups at the pediatrician’s or orthopedist’s office—and early treatment should be initiated.

Despite intensive and long-term conservative treatment, residual hip dysplasia may persist.

The chances of success with conservative treatment decrease with age. Severe residual hip dysplasia can no longer be adequately improved through conservative treatment starting at the end of the second year of life.

Intensive, specialized Vojta physical therapy is still very effective when used as an adjunct during the first year of life. However, it begins to lose effectiveness as early as the second year of life.

Many patients with hip dysplasia between the ages of 20 and 40 experience hip pain that can be unbearable. As a result, they are often unable to work for extended periods. Approximately 200,000 artificial hip joints are now implanted annually in Germany.

Once growth is complete, it is possible to perform a joint-preserving correction for severe hip dysplasia. The procedure is known as a triple pelvic osteotomy. It was developed in the Municipal Clinics of Dortmund in the mid-1970s by Prof. Dr. Tönnis and K. Kalchschmidt.

This surgery is one of the largest and most complex orthopedic pelvic procedures. As a result, it is performed frequently and with specialized expertise at only a few hospitals in Germany.

To correct an overly steep hip socket using a triple pelvic osteotomy, three surgical approaches are required. Through these,

• the ischium,
• the ilium, and
• the pubic bone

are cut. These three bones form the hip socket. The bones are fixed in the required corrected position using screws.

The average duration of the surgery is approximately two and a half to three hours.