by Matthew Harris MD, MBA
Most adults find themselves in one of three categories when it comes to Adult Hip Dysplasia. Some of my patients are generally aware that they had "something" wrong with a hip when they were a baby because their parents may have mentioned having to wear a cast but they don't recall exactly for what. But because their Doctor said not to worry, "everything will be fine," nothing more was ever done, and life went on. But at some point, the patient realized that everything wasn't fine. Maybe it was "OK" but there always seemed to be "something" wrong with one or both of their hips. Perhaps it would hurt from time to time, or maybe they had to stop doing cross-fit, or playing hockey, or doing deep squats because it would cause too much pain.
Then, there are the patients who come in having been able to essentially do everything they have ever wanted to do their entire lives, but for whatever reason, suddenly they have hip pain. These are my patients who experience the shock when I inform them that they not only have Hip Dysplasia, but they have likely had it their entire lives. See the Section on Developmental Dysplasia of the Hip in Children.
Last but not least are my patients who have always known that there was something wrong with one or both of their hips, and they have lived in fear of when the day would come that they would need a dreaded hip replacement. Fortunately for these patients, Orthopedics has come a long way since the day they were told this, and we have an entire armamentarium of surgeries and techniques that can be used to not simply avoid a hip replacement surgery, but more importantly, restore their hip joint to better than it has felt in a very long time... sometimes even back to normal.
A closely related phenomenom to Adult Hip Dysplasia is FAI (Femoroacetabular Impingement) which is discussed in greater detail on the next page. Regardless of what the underlying cause for the dysplasia is, there are many available treatments for patients that are designed to correct the abnormal anatomy, in the hope of reversing any early arthritic changes that have already occurred.
Diagnosing Adult Hip Dysplasia: Performing a thorough physical examination on an adult patient who is experiencing symptoms from dysplasia is likely to yield a diagnosis before any radio-imaging needs to be obtained. That being said, XRays, MRI's and sometimes even CT scans are used by Orthopedists in order to classify the severity of the Dysplasia, to look for any additional associated conditions such as a labral tear, and then to use all of that information to formulate a treatment plan that will likely have the best outcome in that particular patient. The level of severity, and the degree of associated damage to structures such as the cartilage, the labrum and the underlying bone will dictate what treatment options are available.
Treating Adult Hip Dysplasia: We prefer to take a conservative approach for all patients who are newly diagnosed with this condition. Oftentimes with a dedicated trial of anti-inflammatory medications, supervised PT for at least 2-3 months that is designed specifically for Hip Dysplasia, alone with various lifestyle modifications (dieting, avoiding exacerbating activities, stretching), we can return patients to their baseline level of functionality without the need for any surgery or injections. Even in more severe cases, it is still worth attempting conservative management for a number of reasons.
If and when this fails to alleviate the pain, or when a patient's quality of life is so adversely affected that surgery becomes the only option, we proceed in a step-wise fashion to address the dysplasia. Here at the JPLRC, we specialize in Joint Preservation Surgery. This means that our paramount goal is to help you preserve as much of your native cartilage as possible, while also trying to help you regenerate cartilage that has already been lost or damaged. We have a spectrum of techniques and surgeries to accomplish all of this. Dr. Harris has extensive training in both arhtroscopic and open treatment options for joint preservation of the entire lower extremity, and is the only formally trained surgeon in Florida who can offer both of these approaches when treating the hip. We want you to utilize as much of your healthy cartilage as you can, and delay the need for a joint replacement surgery for as long as possible.
Some of the treatment options that we offer at The JPLRC for treating adult hip dysplasia include Hip Arthroscopy, Femoral Osteotomy and realignment, Surgical Hip Dislocation, as well as, Pelvic Osteotomy. Combined with the administration of Stem Cell treatments, PRP injections, Microfracture, as well as, more advanced techniques for promoting cartilage healing and regeneration, we are often able to put years back on your already damaged joints. Every patient is unique, and there is no one treatment protocol. That being said, you can be assured that every effort will be made to preserve your hip joint for as long as possible while ensuring that your pain and functionality return to the levels that you are seeking.