Adolescent and Young Adult Hip Dysplasia

David D. Spence, Derek M. Kelly, Marc J. Mihalko and James L. Guyton

Disclosures

Curr Orthop Pract. 2013;24(6):567-575. 

In This Article

Abstract and Introduction

Abstract

Hip pain in adolescents or young adults can be caused by hip dysplasia, which if left untreated may cause early degenerative hip arthritis. The aims of surgical treatment are to correct the abnormal hip morphology and improve loading across the joint to delay or prevent the onset of osteoarthritis. Patients with a closed triradiate cartilage and with symptomatic acetabular dysplasia but with no signs of arthritis or only minimal arthritis will benefit from a periacetabular osteotomy. Patients with severe cartilage damage should probably be treated conservatively for as long as possible until a total hip replacement can be performed. This review describes the natural history, etiology, diagnosis, and treatment of this condition and reports the newest findings in the literature.

Introduction

Hip pain that develops in an adolescent or a young adult may be indicative of abnormal hip development. Childhood developmental dysplasia of the hip (DDH) is a well-known source of hip arthrosis if left untreated. Despite the numerous neonatal and postnatal screening protocols and imaging techniques that are in place for well-baby examinations some children present after 18mo of age with hip dysplasia that was previously undiagnosed.[1,2] In addition, some children diagnosed with and treated for DDH may have residual dysplasia that remains clinically silent until skeletal maturity. Others still may have stable and radiographically normal hips during infancy and childhood, only to develop signs and symptoms of dysplasia during adolescence,[3] which evidence suggests might be a different disease process. The earlier that treatment is initiated for symptomatic hip dysplasia, the better the chance will be that a patient will have normal hip and acetabular development.[4] Symptomatic hip dysplasia in an adolescent or young adult may require surgical treatment, including osteotomy and a soft-tissue procedure, to restore hip biomechanics and provide joint stability in an effort to slow the onset of osteoarthritis.[4,5] Conservative treatment, such as nonsteroidal antiinflammatory medication, activity modification, and physical therapy may be indicated in mild disease or to delay total hip arthroplasty in patients who are no longer candidates for realignment osteotomy. The type of osteotomy and soft-tissue procedure depends largely on the age of the patient, the severity of the deformity, the hip morphology, and whether or not there is labral damage or osteoarthritis present.[4] After skeletal maturity, careful patient selection is critical in obtaining a good clinical outcome.[6,7] This review focuses on the newest literature available concerning the diagnosis and treatment of hip dysplasia in adolescents and young adults.

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