Hip dysplasia

What does hip dysplasia mean?

The hip joint is a ball-and-socket joint: the femoral head (thigh bone) lies in the socket (acetabulum) of the pelvis. In hip dysplasia, the socket is too flat or poorly aligned. As a result, the femoral head is insufficiently covered - the contact area is smaller, the pressure on the cartilage and labrum (joint lip) increases and the joint tends to become unstable.

• Typical: reduced lateral canopy coverage (low LCE angle according to Wiberg)
• Often accompanied by: changed inclination of the socket (acetabulum is tilted forward/upwards)
• Consequence: Overloading of the labrum and cartilage, mechanical irritation, early wear (coxarthrosis)

A distinction is made between clear dysplasia and so-called “borderline” forms. The latter are borderline insufficient and can still cause problems under higher loads.

Symptoms: How do you recognize hip dysplasia?

• Groin pain, often stabbing or deep (“C-sign”)
• Feeling of instability or “folding” in the hip
• Start-up pain after sitting, discomfort when walking/standing for long periods
• Cracking, snapping or locking sensation (often due to labral irritation)
• Pain when turning, squatting deeply or sitting in the car for long periods
• Radiation into the buttocks or the front of the thigh
• Exercise-related limping, occasionally Trendelenburg sign (gluteus medius weakness)

Complaints can occur in phases. Sports (e.g. running, directional games) and activities with strong flexion/rotation stress often provoke symptoms. If the joint damage is advanced, pain at rest and discomfort at night occur.

Causes and risk factors

Most dysplasias are congenital or occur in the first few months of life when the socket does not form normally. In adults, dysplasia sometimes only becomes apparent in adolescence or young adulthood - often through sport or increased everyday stress.

• Genetic predisposition and familial accumulation
• Breech position, tight space in the womb
• Malformation/lack of maturation of the socket in early development
• Hypermobility/laxity (e.g. higher Beighton score)
• Unfavorable torsion conditions: increased femoral neck antetorsion or socket version
• Factors of upbringing in infancy (tight swaddling - less common today due to education)

Women are more commonly affected. In adults, a combination of slight undercoverage and high levels of physical activity can trigger symptoms, even though no therapy was necessary in childhood.

Examination and diagnostics

The basis is the structured conversation (anamnesis) with a description of the pain, accompanying noises, feelings of instability and triggering movements. This is followed by an orthopedic examination with functional and stability tests.

• Gait, leg axis, pelvic position; Trendelenburg test
• Mobility (flexion/extension, internal/external rotation, abduction/adduction)
• Provocation tests for instability and labrum (e.g. Anterior Apprehension, FADIR/FABER)
• Assessment of trunk and hip muscles, especially abductors

Imaging: Standardized x-rays are essential for assessing the bony roof. Measured values ​​are always interpreted in the overall context.

• X-ray pelvis a.-p. and if necessary additional recordings (false profile, Dunn projection)
• LCE angle (Wiberg): <20° dysplasia, 20–25° borderline; other angles (Tönnis/Sharp angle)
• Assessment of Shenton line, socket/femoral neck version, signs of osteoarthritis (Tönnis grade)
• MRI/MR arthrography: Depiction of labral and cartilage damage, inflammation/edema
• CT (rare): 3D analysis of complex torsion problems, weighing up the radiation economy
• Ultrasound: standard in infant screening; in adults for soft tissue and injections

A diagnostic, ultrasound- or x-ray-guided intra-articular injection can help narrow down the source of the pain (temporary pain relief suggests the hip joint as the cause).

Differential diagnoses: What can look similar?

• Femoroacetabular impingement (cam/pincer) – can also occur in combination with dysplasia
• Labral lesion without significant dysplasia
• Hip capsulitis/synovitis, reactive inflammation
• Coxitis (infectious/inflammatory), rare but important
• Coxa saltans externa (snapping hip, iliotibial band encroachment)
• Trochanteric pain syndrome, trochanteric bursitis
• Stress fracture of the femoral neck, osteitis pubis
• Lumbar or SIJ-related pain with radiation

The exact diagnosis is crucial because therapy goals (stability vs. impingement relief) are different. If the problem is combined, treatment is planned in stages.

Conservative therapy: Our first step

Structured, conservative treatment is the top priority for adolescents and adults with hip dysplasia. The aim is to reduce pain, stabilize the hip and adapt to everyday and sports stress.

• Education & activity control: temporary reduction of provocative movements (deep bend, forced adduction/internal rotation, explosive change of direction)
• Physiotherapy with a focus on stability: strengthening the gluteus medius and maximus, deep external rotators, core and pelvic control
• Neuromuscular training/proprioception: single-leg stance, step-downs, controlled hip abduction
• Mobility: gentle capsule/soft tissue work without final position aggression; Do not “expand” dysplasia-related instability
• Everyday ergonomics: Sitting with your hips slightly open, avoiding extreme cross postures
• Load-adapted sports: cycling, swimming, elliptical machines; Measure the running circumference carefully
• Weight management and general conditioning to relieve pressure on the joint
• Medication: if necessary, analgesics/anti-inflammatory drugs (e.g. paracetamol, NSAIDs) according to individual tolerance

Bandages or orthoses have limited use on the hip. Technique, training dosage and muscular control are crucial. We will work with you to create a practical step-by-step plan that is based on everyday life and sport.

Injections and regenerative procedures: when does it make sense?

Targeted injections can temporarily relieve pain and allow for a training period. They do not replace causal correction of the bony geometry, but can be considered as a component of conservative therapy.

• Cortisone-containing injection intra-articular: can dampen inflammatory activity; use repeated doses cautiously
• Hyaluronic Acid: Evidence for Hip Mixed; can be discussed as a symptomatic option in selected patients
• PRP (platelet-rich plasma): Data for hip joint pain is heterogeneous; Benefits must be considered individually
• Ultrasound or X-ray assisted technique for accurate placement and risk minimization

We will discuss the benefits, limitations and possible side effects with you transparently. Regenerative procedures are only used when appropriate; a guaranteed effect cannot be promised.

Surgical options: overview and indications

If significant pain, instability or progressive damage persists despite consistent conservative measures, joint-preserving surgery may be considered. The choice of procedure depends on anatomy, cartilage status, age, activity level and individual goals.

• Periacetabular Osteotomy (PAO): Correction of socket alignment for better coverage; suitable for congruent joints and still preserved cartilage
• Arthroscopy: can address labral lesions; in the case of relevant dysplasia alone is often not sufficient (instability remains); if necessary combined with PAO in specialized centers
• Corrective osteotomies on the femur: in cases of pronounced torsional deviation
• Hip endoprosthesis: for advanced osteoarthritis and joint-preserving options have been exhausted

As a conservative-oriented practice in Hamburg, we provide diagnostics, indications and second opinions. For surgical therapy, we work with experienced, national centers and support you in preparation and aftercare.

Rehabilitation, training and everyday tips

In everyday working life, height-adjustable workstations, regular getting up and short active breaks help. Sleeping positions with the hips slightly open (lying on the side with a pillow between the knees) are often found to be comfortable.

Prognosis and prevention

If left untreated, severe dysplasia can lead to premature cartilage wear. Through targeted stabilization, load control and – if necessary – timely corrective interventions, symptoms can often be significantly reduced and joint function can be maintained for longer.

• Early detection in childhood (U3/U4 screening) improves the long-term prognosis
• In adults, consistent conservative therapy is key
• Address risk factors such as overuse and poor technique in sport
• Regular follow-up if symptoms persist

Hip dysplasia in children versus adults

In infancy and toddlerhood, hip dysplasia is primarily treated with splints (e.g. Pavlik bandage) - this falls into the specialty of pediatric orthopedics. We are a practice with a focus on teenagers and adults. If necessary, we arrange specialist pediatric orthopedic consultations and coordinate transitions.

For adolescents/adults, the focus is on optimizing function and – if necessary – assessing possible joint-preserving operations.

Warning signs: When should you seek medical advice quickly?

• Acute, severe hip pain after trauma or sudden event
• Fever, significant redness/warmth or pain at rest at night without explanation
• Increasing inability to bear weight with limping, especially if a stress fracture is suspected
• Newly occurring neurological deficits (numbness/loss of strength) – clarification also related to the spine

If signs like these occur, it makes sense to examine them promptly to rule out serious causes.

Your appointment in Hamburg: What we do for you

In our practice at Dorotheenstrasse 48, 22301 Hamburg (Winterhude) you will receive a careful, guideline-oriented assessment and conservative treatment of hip dysplasia. We take time for anamnesis, clinical functional analysis and the classification of your imaging.

• Individual information and therapy planning (conservative first)
• Physiotherapy and training concepts with specific exercise goals
• Ultrasound-assisted injections if indicated
• Coordination of further diagnostics (MRI/MRA) via partners in Hamburg
• Second opinion and referral to designated centers if there is an indication for surgery
• Aftercare and rehabilitation support after procedures

We see ourselves as your pilot team – transparent, evidence-conscious and without promises of cure.

Common misconceptions

• “More stretching always helps.” – If you are unstable, aggressive stretching can increase symptoms.
• “Arthroscopy solves every hip problem.” – In case of dysplasia, instability must be taken into account.
• “The dysplasia can be eliminated with training.” – Muscles stabilize, but do not change the shape of the bones.
• “Jogging is generally forbidden.” – Running can be possible in doses and symptom-oriented; individual advice is important.