Congenital & Acquired Hip Disorders
What is a congenital hip disorder?
Congenital hip disorders occur when a child is born with (or quickly develops) an abnormality in the hip joint. Developmental dysplasia of the hip (DDH) and congenital dislocation of the hip (CDH) are the commonest congenital hip disorders. In both cases, the hip joint socket is shallow and typically maloriented. Hip dislocation, meaning that the ball is not located in the socket, distinguishes CDH from DDH.
With DDH, the abnormal hip joint causes instability of the hip, which is usually subtle, and also abnormal contact between the cartilage of the femoral head (ball) and the acetabulum (socket), which can accelerate degeneration of the cartilage and lead to early arthritis and pain. Differences in leg length may also occur.
Today, CDH is frequently detected shortly after birth, or even in the womb, and is promptly treated. However, in the past and in countries outside of the United States the diagnosis has been missed, and patients grow up with one or both hips dislocated. Remarkably, they usually have no hip pain, but they may have unequal leg lengths, limp, or eventual back pain.
What are some other common hip disorders?
There several other common hip disorders that develop during childhood and can lead to hip degeneration and pain. These conditions are often detected during childhood and adolescence. Depending on their severity at the time initial presentation, a pediatric specialist may provide surgical treatment. However, later in life further hip joint deterioration and pain may occur that necessitates either nonsurgical or surgical care.
Some common disorders include:
Legg-Calvé-Perthes Disease (LCP)
Legg-Calvé-Perthes disease is a relatively rare childhood hip condition that affects children ages 4 to 8 years. The condition occurs when the blood supply to the femoral head (ball) is disrupted for unknown reasons. This causes the bone cells in the femoral head to die in a process known as “avascular necrosis”. The bone usually heals, but its shape is frequently distorted and not spherical. Therefore, the ball no longer fits perfectly into the socket. The hip can function well for decades without significant pain, but early hip arthritis in the 40’s or 50’s is common.
Slipped Capital Femoral Epiphysis (SCFE)
Slipped capital femoral epiphysis occurs when the femoral head (ball) slips off the neck of the thigh bone (femur). The slip occurs at the level of the growth plate. It’s appearance is analogous to the ice cream scoop falling off its cone. This disorder generally occurs in adolescents around the onset of puberty. Depending on the severity of the slip, nonsurgical or surgical treatments are provided. Regardless of treatment, there often remains an imperfect shape of the femoral head and head-neck junction that may lead to hip impingement and eventual hip joint degeneration and pain in adulthood.
Other Skeletal Dysplasias
Skeletal dysplasias are genetic conditions that affect the entire skeleton. They result in abnormal bone development throughout the body, including the hip. Short stature, uneven limbs, or unusual limb proportions are common features. Some of the responsible genes influence cartilage development and quality. The abnormal shape of the joints, along with poorer quality cartilage, predispose patients with some skeletal dysplasias to early arthritis, which may require total hip replacements and/or total knee replacements early in life.
What are the symptoms of these hip disorders?
Symptoms can vary among patients depending on the type and severity of the disorder, but may include:
- Different leg lengths
- Limited range of motion, excessive range of motion, or abnormal range of motion of the hip(s)
- Inability to walk or bear weight on the affected leg
- Hip discomfort or pain walking or performing everyday tasks
- Hip discomfort or pain with prolonged sitting and/or standing
- Back pain
How is a congenital hip disorder diagnosed?
Congenital and acquired hip disorders are typically identified during childhood or adolescence. Subtle disease may be missed. Previously treated and subtle disease may predispose to hip joint degeneration and hip pain. When hip pain occurs that is not responsive to a short course of rest, ice, and over-the-counter anti-inflammatory medications, evaluation by a hip specialist is advisable.
In adulthood, the assessment of hip pain is similar to other patients without a previous history of hip disease. However, the treatment of these hips is often more complex, particularly if a prior surgery has been performed.
How are congenital hip disorders treated?
Treatment focuses on improving function and alleviating pain. Early detection of hip disorders typically provides patients with more options for treatment. Depending on the severity of the hip disorder, either nonsurgical or surgical treatment options may be recommended:
- Making certain lifestyle modifications
- Avoiding high impact activities
- Losing weight
- Physical therapy
- Anti-inflammatory medications
- Hip injection
- Hip arthroscopy
- Hip osteotomy (surgical realignment of the bone)
- Hip resurfacing
- Total hip replacement
If you believe you may be suffering from a congenital or acquired hip disorder, such as hip dysplasia, it is important to seek advice from an orthopedic hip specialist to accurately diagnose and treat your condition. Dr. McLawhorn is a hip and knee reconstruction specialist at Hospital for Special Surgery serving patients in New York and Connecticut, with extensive training in diagnosing and treating hip disease, including congenital and acquired hip disorders. To learn more, call 203-705-2113 (CT) / 212-606-1065 (NYC) today or schedule an appointment by using the form on this page.