Adolescent Hip Dysplasia

Author David Slattery

FRACS (Orth), MBBS(Hons), LLB, FAOrthA — Orthopaedic Surgeon

What is Adolescent Hip Dysplasia?

Hip dysplasia describes a hip in which the acetabulum (the socket of the hip joint) is too shallow or poorly oriented to adequately cover the head of the femur (the ball). In adolescents and young adults, this lack of coverage means the load across the joint is concentrated over a smaller area, which can lead to instability, labral tears, cartilage damage, and early wear of the joint.

Adolescent hip dysplasia may be a continuation of a problem present from earlier in life, or it may become apparent during the teenage years or early adulthood as activity levels increase and symptoms develop. Recognising and addressing it is important because untreated dysplasia is a recognised cause of early hip arthritis.

Anatomical diagram of the hip joint labelling the pelvis, acetabulum (socket), labrum, femoral head (ball) and femur
In a normal hip the acetabulum covers the femoral head well. In dysplasia the socket is shallow or poorly oriented, so load concentrates over a smaller area.

Causes

Dysplasia reflects the way the hip socket has developed. Contributing factors can include a family history of hip dysplasia, a history of developmental dysplasia of the hip (DDH) in infancy, and individual variations in the shape and orientation of the acetabulum(hip socket). In many cases it represents the natural development of the joint rather than a result of injury.

Symptoms

  • Groin or hip pain, or pinching often related to activity
  • A sensation of the hip clicking, catching, or giving way
  • Pain with prolonged walking, standing, or sport
  • A feeling of instability in the hip
  • Symptoms that develop gradually over time, sometimes without a clear injury

Diagnosis

Diagnosis of hip dysplasia is based on the history and a clinical examination, supported by detailed imaging. X-rays are used to assess the coverage and orientation of the socket and to take specific measurements that quantify the degree of dysplasia. MRI may be used to assess the labrum and cartilage, which are commonly affected. Accurate assessment of the bony anatomy is central to planning treatment.

X-ray comparing two normal hips with a dysplastic hip showing a shallow socket and partial femoral head coverage
Left: two normal hips. Right: the red arrow shows a dysplastic hip — a shallow socket with only partial coverage of the femoral head.
X-ray of a dysplastic left hip with measurement lines showing a sloping acetabular roof, joint dislocation and reduced femoral head coverage
Measurements used to quantify dysplasia: a sloping roof (purple versus green), joint dislocation (yellow arrow, break in the pink line), and reduced femoral head coverage (red line).

Treatment Options

Treatment depends on the severity of the dysplasia, the symptoms, the condition of the cartilage and labrum, and the patient’s age and goals.

Non-surgical treatment

  • Physiotherapy to strengthen the muscles supporting the hip
  • Activity modification – avoiding pain generating activities
  • Pain-relieving measures such as medications and injections

Non-surgical treatment can help manage symptoms but does not change the underlying shape of the socket.

Surgical treatment

Where dysplasia is significant and the joint is still well preserved, joint-preserving surgery to improve the coverage of the femoral head may be considered — most notably periacetabular osteotomy (PAO), which repositions the socket to provide better coverage and more even load distribution. Where the labrum or cartilage is damaged, this may also be addressed. The most appropriate approach depends on individual factors and will be discussed with you at your consultation. (See also the Periacetabular Osteotomy and Hip Preservation Surgery pages.)

Diagram of a periacetabular osteotomy showing four cuts in the pelvic bone and the socket repositioned
(A) Four cuts are made in the pelvic bone. (B) The fragment is repositioned to deepen coverage.
X-ray after periacetabular osteotomy, the acetabulum repositioned and held with screws
After a PAO the acetabulum is repositioned and held with screws while it heals.

Recovery and Outlook

Addressing significant dysplasia in a well-preserved joint aims to improve symptoms and reduce the risk of early arthritis over the longer term. Recovery depends on the specific treatment undertaken — joint-preserving surgery involves a structured, staged rehabilitation — and will be explained in detail according to your circumstances.

Frequently Asked Questions

Why does hip dysplasia matter if it isn’t very painful yet?

Dysplasia concentrates load across a smaller area of the joint, which over time can lead to labral tears, cartilage damage, and early arthritis. Identifying and addressing significant dysplasia while the joint is still well preserved offers the best opportunity to protect the hip in the long term.

is Hip Dysplasia Present from birth?

Hip dysplasia can be present from birth, and it is often picked up in babies and children as part of screening programs. It can also develop as the hip grows from the birth into adolescence. 

Can I pass on hip Dysplasia to my Children?

Yes. If you have hip dysplasia there is a strong chance (up to 30-40%) that you can pass it onto your children. 

Do I have to have surgery to fix hip dysplasia?

No. Many patients have hip dysplasia but have no symptoms. In such cases generally you can be monitored, but this depends upon the individual. 

Can physiotherapy fix hip dysplasia?

Physiotherapy can help manage symptoms by strengthening the muscles around the hip, but it does not change the underlying shape or coverage of the socket. Where dysplasia is significant, surgical options that address the bony anatomy may be considered.

What is a periacetabular osteotomy?

A periacetabular osteotomy (PAO) is a joint-preserving operation that repositions the socket of the hip to provide better coverage of the femoral head and distribute load more evenly. It is one of the main surgical options for significant dysplasia in a well-preserved joint.

Medical Disclaimer
The information on this page is intended as general patient education and does not constitute medical advice. Every patient is different, and treatment decisions should always be made in consultation with a qualified medical professional based on your individual circumstances, health history, and imaging. Outcomes from treatment vary between patients and cannot be guaranteed. If you have concerns about your hip health, please contact Dr Slattery’s rooms to arrange a consultation.

Contact Dr David Slattery.

Contact Dr David Slattery’s rooms to book an appointment or speak with our team about referrals, availability, and treatment options.