Experience the Best Physiotherapy at Hip Dysplasia Physio
When to suspect Hip Dysplasia with your patient?
Sadly many teenagers and young adults go undiagnosed for consecutive years when they have hip dysplasia. A study by Nunley et al in 2011 showed that on average it took 5 years having seen 3.5 clinicians before a patient received a diagnosis of hip dysplasia.
This delay in diagnosis can lead to psychological effects as patients feel unsupported, stressed and anxious, as well as detrimental effects in care and management of the hip.
Early detection of hip dysplasia allows for increased treatment options, including both hip preservation surgery and conservative treatment, which delays the progression of osteoarthritis (Gambling and Long 2019).
The diagnostic criteria for patients with hip dysplasia lacks consensus, particularly in adults. The Ottawa group, Wilkin et al, 2017, defined 3 main classifications of acetabular dysplasia; Anterior, Posterior and Lateral/or Global.
Many patients who have missed dysplasia have previously had an x-ray, which was reported as normal or no bony abnormality seen or no OA. My advice is to always review the x-ray image yourself and complete some of the simple angles such as Lateral centre edge angle (LCEA), Sourcil angle or Acetabular index (AI), as well as look for signs such as cross-over sign or ischial spine sign which may indicate retroversion.
Diagnosing the dysplastic patient is complex due to the variation in signs and symptoms. Hip dysplasia patients often present with secondary conditions such as gluteal tendinopathy (GTPS), Psoas issues, or lumbopelvic pain. If these conditions are diagnosed in isolation, practitioners may miss an underlying hip joint pathology. Hip dysplasia often co-exists with impingement signs both on clinical examination and radiographically. Iliopsoas tendinopathy is rarely a primary cause of pain and should always raise a suspicion of hip dysplasia (Jacobsen et al 2018).
When it comes to physical examination, it is important to remember that tests for intra-articular pathology are sensitive but not specific and if tests such as FADIR are positive, this doesn't define FAIS alone.
The typical hip dysplasia patient may report a history of insideous onset of groin pain which is activity related but eased with rest (Nunley et al 2011). Symptoms may eventually become irritable with prolonged postures such as sitting or standing. Symptoms can occur after an unusual increase in activity (running a marathon) or post child birth. Up to 50% of hip dysplasia patients have hypermobility. Patients often report pain over the anterior hip, groin pain, lateral hip, and c-sign is present (Schmitz et al 2020 and Dick, Houghton and Bankes, 2018).
Hip dysplasia patients often report mechanical symptoms such as catching, clicking, clunking, popping, locking or giving way, as well as reporting feelings of instability (Nunley et al, 2011). Night pain was present in up to 60% of the Nunley study patients.
Patients with hip pain should always be screened for hip dysplasia risk factors such as breech presentation, birth history if known, family history of hip issues, any issues with hips as a child, family history of EDS, first born.
Conservative management of Hip Dysplasia
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Surgical management of Hip Dysplasia
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