Understanding Hip Dysplasia

• What causes Adolescent Hip Dysplasia?

  The cause of adolescent and adolescent hip dysplasia is obscure. Doctors are just becoming aware that infant screening detects only 10% of dysplasia that causes arthritis in adolescents. Hip instability in babies can usually be detected, but one possibility is that some babies have shallow sockets that fail to develop completely or become unstable at an older age. These would not be detected by current methods. There is increasing interest in identifying and treating babies that have shallow sockets that are currently considered borderline normal. Infant hips that are in the lowest 1% of hip development by measurement are usually treated, but perhaps that needs to be reconsidered so that babies in the lowest 5% by measurement are treated. This would require research to prove that early treatment might help prevent adolescent arthritis. Also simpler and cheaper methods need to be developed if widespread treatment is used for prevention. The International Hip Dysplasia Institute is on the leading edge of these concerns and is directing some of its research efforts towards discovering new methods of prevention that may be possible.

  The known causes of hip dysplasia are mainly related to loose hips around the time of birth. This is often due to normal hormones that help relax ligaments to make childbirth easier. The left hip is more frequently involved than the right because of the normal baby position in the womb that stretches the left hip more than the right. Some instability has been identified in as many as 15% of newborn infants. Contributing factors for hip dysplasia are first born babies (not as much room), girls (more ligament laxity), positive family history, and breech position that stretches the hips. When one person in the family has hip dysplasia, the chance of hip dysplasia needing treatment is 5-10% for subsequent children (1-2 in 20).

• How common is Adolescent Hip Dysplasia?

  Hip dysplasia in adolescents is the most common cause of hip arthritis in young women. Men also have hip dysplasia and account for approximately one in five cases. Estimates of hip dysplasia as a cause of all hip arthritis range from 5% to 44%. The best guess is that 10% of all total hip replacements in the United States is because of hip dysplasia. This means that approximately 35,000 total hip replacements each year in the USA are because of hip dysplasia. Early detection can prevent some total hip replacements through modern techniques of hip preservation surgery.

  Some hip instability is very common in newborn infants. The exact frequency of hip dysplasia that requires treatment in babies is variable depending on Nationality, sex, race, and other factors. Hip dysplasia that needs treatment occurs in approximately 2-3 children per thousand. However, some studies have detected mild instability in up to one infant in six (15%). Most of this mild instability resolves spontaneously. However, there is renewed interest in whether these that “resolve” are the ones that lead to adolescent hip dysplasia.

• Why didn’t doctors diagnose me when I was a baby?

  Simply put, the current methods of detection are inadequate. Norway has socialized medicine and implemented comprehensive screening over 40 years ago. Ultrasound screening was introduced about 30 years ago. In 2008, some Norwegian researchers looked at total hip replacements in young people. They found that 92% of the adolescent dysplasia had been “missed” in childhood. This is discouraging to doctors because their best efforts have failed to detect hip dysplasia during childhood. The problem is with the methods and not with the doctors themselves. It is becoming more and more clear that dysplasia can develop after infancy or that simple preventive methods need to be developed for more widespread use. The International Hip Dysplasia Institute is attempting to answer some of these questions.

• What are some signs I can look for if I suspect I have hip dysplasia?

  During adolescence or adulthood, the most common first sign is pain in the hip. Most people think of the hip as the bone that protrudes on the upper side of the thigh. However, the hip joint itself is in the middle of the crease where the thigh joins the body. That is where the hip bends and straightens. If there is pain or snapping in the front region of the hip, then the problem is more likely to be inside the joint itself. Pain in this region or in the groin that is aching and becoming worse over a period of several months raises concern about undetected hip dysplasia. Sometimes painful snapping occurs deep in the hip. This is different from snapping of the muscles on the side of the thigh where the muscles roll across the bump on the side of the upper thigh (that is outside the hip joint but is a common location for snapping bursitis). When the snapping is deep in the hip joint, then there may be something torn inside the joint itself.

• Is it important to see a Hip Specialist vs a General Orthopedist if I have Hip Dysplasia?

  Hip dysplasia is often misdiagnosed because the x-rays need to be taken in special positions. The average delay in proper diagnosis is 3 years because the methods of diagnosis are somewhat new to many physicians. If you suspect you have hip dysplasia, and the cause of your pain seems obscure, then a second opinion may be worthwhile. We’ve also suggested some questions to consider asking your doctor that might give you a better feeling about his or her experience with hip dysplasia.

• What happens if Adolescent Hip Dysplasia goes untreated?

  Hip dysplasia in adolescents that is not treated will worsen and eventually require total joint replacement. Exercises and anti-inflammatory canadian pharmacy medicines may help relieve pain temporarily, but the only true solution is to have the hip joint re-aligned so that the pressures on the joint surface are spread over a wider area. This requires surgery and the surgery must be done before the joint surface becomes too worn out to heal. Some doctors may advise putting up with the pain as long as possible but that is rarely the best advice when the cause of pain is dysplasia. Early hip preservation surgery can postpone artificial joint replacement surgery for many people younger than 50 years of age. It is advisable to avoid total hip replacement when possible because hip replacement in young people is less successful than replacement after the age of 50 years.

• What are the advantages of a PAO over a total hip replacement?

  That’s a common question that doesn’t always have a clear answer because each person is different. The decision whether to try to preserve the natural hip or replace the hip completely depends mainly on age, severity of dysplasia, and expected activity level after surgery. Your doctor is the best person to discuss the specifics of your particular situation. If your doctor primarily does total hips and hasn’t done any PAO surgery, then a second opinion from a qualified PAO surgeon is usually a good idea. On the other hand, if your doctor treats children and young adolescents but rarely does total hip replacements, then an opinion from a total hip surgeon may be worthwhile.

  The PAO has the best results in people who are younger than 35 years with good congruency of the ball and socket. Congruency means that the ball has not moved out of the socket but the socket is shallow. Total hip replacements have the best results in people older than 45 years who are willing to limit their activities to make the artificial hip last as long as possible without wearing out.

  Most orthopedic surgeons try to preserve the natural hip as long as there is some good joint surface remaining and the person is younger than 40 to 45 years old. When the hip is displaced and the joint surface is very thin, then total hip replacement is often recommended, especially after age 45 years. The years in between mainly depend on the amount of joint damage that already exists. Successful PAO surgery allows return to full activities for most people and postpones the need for total hip replacement more than ten years in 85% of patients and by 20 years or more in some cases.

  Total hip replacements are very successful, even in young people but the younger population generally doesn’t follow their doctor’s advice after they get an artificial hip and feel good again. The hip will wear out and need replacement more often in younger people because of longer lifespan and greater activity levels. Each time the total hip is replaced, more bone is taken away and the procedure becomes more difficult with greater risk of infection and other complications. So, the problem with total hip replacement is not the first surgery but the next surgery and the one after that. Each time the artificial hip wears out there is an increasing possibility of complications. However, total hip replacement is needed regardless of age when the joint surface has completely worn out.

  As a reminder, your doctor is the best person to tell you how bad your hip has deteriorated and whether your best choice is PAO surgery or total hip replacement.

• Where can I get financial help?

  Keeping Track of Healthcare

  The best way to track of your healthcare, or your child’s healthcare, is to keep your own, personal, set of notes and records. Just a small diary of appointments and treatment events will help remember important events. Your records can also help the doctor(s) treating you/your child, especially if you change doctors or need a second opinion:

  • You don’t need to record every detail, but some notes about recommendations and treatment plans are helpful as a reminder for you and for your doctor.
  • A list of medications, allergies, immunizations, and dates of surgeries or illnesses is useful.
  • If you or your child has other conditions (diabetes, asthma, etc.) your notes will help you transmit information from one doctor to another and keep track of all the things you need to do for each condition.
  • It’s also helpful to keep phone numbers and addresses of all doctors, orthotists, hospitals, and others who may help care for your child.
  • Use your digital phone to take photos of one or two x-rays when they are on the monitor in the doctor’s office. Keep these with the records in case you need them years from now.
  • If you are planning to move or change doctors for any reason, it’s a good idea to ask for copies of your records, x-rays, and laboratory studies to keep at home. It’s easier to collect these records as treatment occurs rather than gather it all later.
  • If you notice errors or inconsistencies in any records, please tell your doctor. Good doctors will appreciate your help because they want to make sure their records are accurate and complete.

  Healthcare Insurance and Financial Assistance

  Knowing your choices will help you be a better advocate for yourself or your family. Financial issues vary from country to country, but are always an important part of medical care. Local governments and hospitals employ social service workers who can help you find financial assistance if you do not qualify for traditional private or public healthcare funding.

  U.S.A. Insurance and Financial Assistance

  For more in depth answers to your questions, the IHDI recommends this Medical Billing and Coding website: https://www.medicalbillingandcoding.org/health-insurance-guide/overview/.

  Specific information is available for the following topics:

  • Overview of Health Insurance
  • Affordable Care Act
  • Medicaid
  • Health Insurance for College Students
  • Navigating Healthcare for the Uninsured
  • Understanding Medical Bills
  • Commercial Health Insurance

  Centers for Medicare and Medicaid Services also provides comprehensive information about regulations including private insurance and government services. https://www.healthcare.gov/ This includes regulations for Pre-Existing Conditions:
  “The Affordable Care Act created the Pre-Existing Condition Insurance Plan (PCIP) to make health insurance available to those that have been denied coverage by private insurance companies because of a pre-existing condition…. everyone will have access to affordable health insurance choices through Health Insurance Marketplaces.” No insurance plan can reject you or charge more because of a condition you had before your coverage started.

  What are the types of insurance?

  Insurance organizations, also called managed care organizations (MCOs) and health maintenance organizations (HMOs) may require you to see a primary care physician first, who will determine whether to refer your child to a pediatric orthopedist. In most cases, the managed care organization will not pay for a visit to a pediatric orthopedist unless you get a referral.

  If you see a pediatric orthopedist without a referral, you may have to pay for all or most of the cost of the visit out-of-pocket and find yourself with no insurance for needed tests or procedures. This is why it is important to check with your health insurance provider to see if a referral is required before a visit to an orthopedic specialist.

  Preferred provider organizations (PPOs) allow you to see only the doctors who belong to the PPO network. If your pediatric orthopedic surgeon is not on the list of approved providers who are part of the PPO plan, you’ll have to pay an extra fee to see him or her.

  These insurance plans are typically offered by employers, but may be purchased by individuals outside of employee benefits.

  What should I know about costs?

  Understanding these terms will help you determine additional cost to you:

  • Premium payment – cost you pay for your insurance plan.
  • Co-payment – the amount you pay for office visits or hospital services.
  • Deductible – the amount you have to pay out-of-pocket before any insurance coverage is applied to services.
  • Extra costs – these amounts may be applied for emergency care or visits to out-of-plan doctors.

  What should I know about choosing a doctor?

  Many people prefer to be treated by a doctor they know and trust. That’s important for the patient who has been seeing the same doctor for years, and for the person who hears good things about the doctor from a relative or close friend. Some important questions to ask about your plan include:

  • Will I be able to see my pediatric orthopedist of choice?
  • Can my pediatric orthopedist join the plan I have already?
  • Does my plan have an option to allow me to see any pediatric orthopedist, even if he or she is not in the plan?

  What if I’m not happy with the plan I have?

  Investigate whether your plan has an appeal process. It may be time consuming, but be active on behalf of yourself and your child. If you are not able to get a quick resolution of your concerns with your plan, changing plans maybe an option. Be aware of clauses in insurance plans that address certain medical conditions that are already being treated. These “pre-existing” clauses may cause a lapse in insurance coverage for certain services needed for your child. 

  What if I do not have health insurance coverage for my child?

  Other options for health insurance coverage that may be available for your child include Medicaid and Child Health Insurance Programs (CHIP). These programs are federally funded and state administrated. They are based on the age of your child and income of your family. Some plans are based on the medical needs of your child. Each state has different rules about the eligibility and the services offered by these programs.

  European Insurance and Financial Assistance

  Healthcare financing varies from country to country in Europe. Most provide universal coverage through national health plans or through highly regulated private health insurance companies along with government subsidies for those who cannot afford to purchase their own health insurance. Each country maintains information websites for those who need assistance.

  Australia and New Zealand Insurance and Financial Assistance

  New Zealand has a mix of public and private healthcare delivery with information available here [https://www.newzealandnow.govt.nz/living-in-nz/healthcare/healthcare-services]

  Australia has a mix of public and private healthcare delivery with information available here  [https://www.health.gov.au/about-us/the-australian-health-system]

  North, Central, South American Universal Health Coverage for Citizens

  The following countries provide universal health coverage by various different methods and with varying accessibility to high quality care.

  • Canada
  • Argentina
  • Bahamas
  • Brazil
  • Chile
  • Columbia
  • Costa Rica
  • Cuba
  • Mexico
  • Peru
  • Trinidad and Tobago

• Where can I find a car seat for a child in a spica cast?

  Car Seat Loaner Program and Services for Children in Spica Casts: A Hospital-based Program ProCarSeatSafety.com

  A Resource provided by Dr. James DeCarli that serves Patients, Physicians, and Hospitals. Disclaimer: While there is a fee involved for additional services. the information and insight offered is free.

This list is meant to answer the most common questions we receive about Hip Dysplasia. If you have questions that are not addressed by this list, please take a look around our website. There is much more information than we are able to list here in our FAQs. If our website is unable to answer your question(s), please Contact Us.