Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia

Abstract

Hip dysplasia is a treatable developmental disorder that presents early in life but if neglected can lead to chronic disability due to pain, decreased function, and early osteoarthritis. The main causes of hip dysplasia in the young adult are residual childhood developmental dysplasia of the hip (DDH) and adolescent-onset acetabular dysplasia. These two distinct disease processes affect the growing hip during different times of development but result in a similar deformity and pathomechanism of hip degeneration. Routine screening for DDH and counseling regarding risks for acetabular dysplasia in families with a history of early hip osteoarthritis may allow early identification and intervention in these hips with anatomical risk factors for joint degeneration.

Keywords: Acetabular dysplasia; DDH; Hip dysplasia; PAO; Periacetabular osteotomy; Residual hip dysplasia.

Fig. 1

a Four different patients who presented at the ages listed above, demonstrating decreasing severity of dysplasia in the images from left to right. b A 1-year-old female child with bilateral developmentally dislocated hips that subsequently underwent bilateral open reductions and spica casting. c The same child at 3 years of age showing hips that are well-seated within the bilateral acetabula. d The same child at 5 years of age showing progression of hip growth and improvement in acetabular remodeling. e The same child returned at 10 years of age complaining of right hip pain. Although the hips appeared symmetric radiographically at the last follow-up at 5 years of age, the right hip has failed to develop adequately and the patient now had symptomatic residual acetabular dysplasia. f The right hip was treated with a periacetabular osteotomy (PAO) in order to improve femoral head coverage by the acetabulum. g The patient at 11 years of age, 1 year after PAO, with no right hip pain and return to all activities