What Is Hip Dysplasia in Older Adults?
Hip dysplasia is the abnormality that occurs due to the poor fit of the femur or thigh bone and pelvis. The socket of the hip is too shallow to support the ball of the hip. It is also known as hip dislocation or acetabular dysplasia. When alignments of the bone get disrupted, many symptoms, such as pain and limping, occur.
Studies found that half of the adults with hip dysplasia have hypermobility, a condition where joints can stretch beyond the range of motion. That means the joint becomes more flexible, leading to increased socket motion.
What Are the Causes of Hip Dysplasia in Older Adults?
Most adults experience hip dysplasia as a leftover problem from childhood. At birth, the exact cause of hip dysplasia is unknown, but family history is a relevant factor. A child is 12 times more likely to develop hip dysplasia if a family member has this condition. The baby's bones in the womb are more soft and pliable; hence the chances of getting misaligned are high.
Other causes of hip dysplasia in newborns include:
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Assigned female at birth.
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Position of the fetus in the womb.
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A baby is born bottom first.
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First born child.
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Low levels of amniotic fluid.
What Are the Signs and Symptoms of Hip Dysplasia in Older Adults?
Older adults with hip dysplasia usually present with the following signs and symptoms:
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Pain in the front of the groin region.
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Muscle pain in the side or front of the hip.
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Increase in hip pain while walking, standing, or running.
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Limping while walking.
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Increase in hip pain at night.
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A sensation of popping or catching during hip movement.
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Some patients may experience pain in the buttocks and knees.
How Is Hip Dysplasia Diagnosed?
Hip dysplasia is diagnosed by combining symptoms, physical examination of the hip, and imaging studies. Certain symptoms may indicate the cause of the hip pain, such as:
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Pain from the front part of the groin may occur due to labral tears, damage of cartilage, or pain in hip flexor muscles.
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Muscle pain in the side of the hip may be due to the overworking of the hip flexor and abductor muscle when the socket is too shallow.
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Patients also suffer from limping due to severe pain. The painless limp may occur due to joint stiffness or weak muscles.
In the physical examination, the doctor may ask the patient to stand still to check for pelvic tilt, the difference in the leg length, or muscle wasting. Then the hip is moved through a full range of motion, after which a few tests are done:
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Trendelenburg Test: This test is performed to determine the functioning of hip abductor muscles. The patient is instructed to stand on one leg. If the hip of the leg lifted also goes up, then the test is negative. While if the hip drops or tilts downwards, then the test is considered positive.
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Impingement Test: This test is performed by flexing the hip, followed by twisting the hip inwards. Most of the patients with hip dysplasia experience a pinching sensation in this test.
X-rays and MRIs (magnetic resource imaging) are used for the diagnosis of hip dysplasia. However, many doctors suggest that a simple X-ray is enough to diagnose hip dysplasia in adults. To check the coverage of the ball and socket joint, X-rays are taken from certain angles. X-rays can also depict whether the hips are misaligned in an upward direction. MRI scanning is often performed to analyze the soft tissues of the pelvis, hip cartilage, and labrum.
How Is Hip Dysplasia Treated in Older Adults?
Treatment options for hip dysplasia include a conservative approach and surgical treatment.
Conservative Approach: Non-surgical methods for treating hip dysplasia are:
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Physiotherapy: It is done in hip dysplasia patients to correct posture, muscle weakness, poor joint awareness, and tendon inflammation. In addition, physiotherapy can also strengthen hip extensors and external rotators and improve gait.
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Modification of Activities: Patients are advised to reduce intense activities and sports that can affect the hip. Practicing swimming or cycling instead of high-impact sports add less stress on the hips. At the same time, a healthy lifestyle, weight loss, and activities can add benefits.
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Injections: Injecting Cortisone into the joints can relieve pain and inflammation for a short duration.
Surgical Treatment: Surgery for hip dysplasia aims at preserving the hip and reducing pain. Two surgical options for adults with hip dysplasia are:
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Periacetabular Osteotomy (PAO): It is considered a gold standard procedure for the treatment of hip dysplasia. PAO is usually advised for people with hip dysplasia without arthritis. In this procedure, the surgeon cuts the bone surrounding the hip socket. Through these cuts, the segment of the bone is rotated and kept in a position that completely covers the joint. Following this, metal screws are used to hold the socket in place.
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Total Hip Replacement (THR): Damaged bone and cartilage are removed during this treatment, and prosthesis are used in their place. Total hip replacement is indicated in the cases of hip osteonecrosis, femoral neck fractures, hip dysplasia, and hip fractures. THR is preferred when the conservative treatment methods do not show any improvement. In this procedure, the femoral head is replaced with a prosthetic head. The approaches for THR are posterior, direct anterior, and direct lateral.
What Are the Complications of Hip Dysplasia in Older Adults?
In certain cases, hip dysplasia can lead to the following complications:
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Hip Labral Tear: Labrum is a soft tissue that surrounds the socket or the acetabulum of the hip. Any injury, structural or degenerative issues can cause tears in the labrum. Hip dysplasia is also a cause of labral tears.
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Osteoarthritis: It is a degenerative disease of the joint and is common in older people.
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Dislocated Joint: Long-term hip dysplasia can cause the bones to slide out of the joint.
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Unstable Joint: Hip dysplasia, in some cases, can cause looseness in the joint. This can lead to pain and weakness in the joint.
Conclusion
Hip dysplasia is a disorder in which the hip's ball and socket joint does not function correctly. In most people, hip dysplasia is present from birth. If it develops in adulthood, it occurs as a leftover condition of childhood hip dysplasia in many cases. Hip dysplasia is a painful disorder that can lower a patient's quality of life. However, conservative and surgical options can treat this condition to a certain extent. Older people with hip dysplasia can lead a normal life with proper medical care and support.
