Hip Clinical Pearls: #9 Hip Dysplasia |
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Clinical Pearl #9: Hip Dysplasia
As previously discussed, hip dysplasia is insufficient bony coverage of the acetabulum around the head of the femur. Stability at the hip is directly related to bony coverage. Normal coverage allows for the ball and socket joint to effectively rotate and glide with various movements around the ligamentum teres, or the ligament inside the hip socket assisting in stability of the joint. Without sufficient bony coverage, this creates a micro instability. What this means is that instead of the ball rotating around a steady point within the joint, it will shift within the joint while it rotates. This places excess strain to the cartilage within the joint, the ligamentum teres, the joint capsule and the muscles surrounding the joint.
JOINT DAMAGE:
Excess shear forces were previously discussed in the FAI section relating to joint damage. Shear forces also occur within a dysplastic joint creating labral tearing, ligamentum teres tearing and injuries to the articular cartilage. Cartilage damage can be a direct contributing factor in hip pain. The mechanism by which these damages happen is different. Although shear forces occur in both FAI and dysplasia, damage with dysplasia is related to excess movement within the joint. FAI is related to bone outside of the joint altering joint mechanics contributing to damage. “Fixing” cartilage damage within a dysplastic joint will not take into consideration the instability which contributed to the injuries, thus the underlying issue will persist. “Fixing” cartilage damage within a stable, bony joint and addressing the impingement which caused the damage with FAI will mitigate the underlying issue, thus maximizing the outcome of “fixing” cartilage damage.
We know that the hip needs sufficient bony formation which allows ligaments to maximize their function, keeping cartilage within the joint healthy. Hip instability not only means that the ligaments have to work harder, placing more stress on cartilage, but that it relies on muscles to create joint stability. We know that muscles are made to move, stretch and support joints. They are not intended to create joint stability. This constant muscle strain makes it difficult for muscles to operate in the manner for which they intended. In turn, this strain creates pain within the body not only with physical activity, but with day to day activities as well.
DIAGNOSIS AND TREATMENT OPTIONS:
X-rays and CT scans are commonly used to help diagnose hip dysplasia. Your hip specialist will take these into consideration along with your MRI to give you a holistic idea of how your bony anatomy relates to soft tissue issues within and around the joints as well as how other ailments may relate. Keep in mind that while Physical therapy will not change your bony anatomy or cartilage damage, it can help to address the muscular deficits accompanying this diagnosis to help improve pain and daily function. Surgical intervention, a Periacetabular Osteotomy, may be a potential end result to help move forward.
As previously discussed, hip dysplasia is insufficient bony coverage of the acetabulum around the head of the femur. Stability at the hip is directly related to bony coverage. Normal coverage allows for the ball and socket joint to effectively rotate and glide with various movements around the ligamentum teres, or the ligament inside the hip socket assisting in stability of the joint. Without sufficient bony coverage, this creates a micro instability. What this means is that instead of the ball rotating around a steady point within the joint, it will shift within the joint while it rotates. This places excess strain to the cartilage within the joint, the ligamentum teres, the joint capsule and the muscles surrounding the joint.
JOINT DAMAGE:
Excess shear forces were previously discussed in the FAI section relating to joint damage. Shear forces also occur within a dysplastic joint creating labral tearing, ligamentum teres tearing and injuries to the articular cartilage. Cartilage damage can be a direct contributing factor in hip pain. The mechanism by which these damages happen is different. Although shear forces occur in both FAI and dysplasia, damage with dysplasia is related to excess movement within the joint. FAI is related to bone outside of the joint altering joint mechanics contributing to damage. “Fixing” cartilage damage within a dysplastic joint will not take into consideration the instability which contributed to the injuries, thus the underlying issue will persist. “Fixing” cartilage damage within a stable, bony joint and addressing the impingement which caused the damage with FAI will mitigate the underlying issue, thus maximizing the outcome of “fixing” cartilage damage.
We know that the hip needs sufficient bony formation which allows ligaments to maximize their function, keeping cartilage within the joint healthy. Hip instability not only means that the ligaments have to work harder, placing more stress on cartilage, but that it relies on muscles to create joint stability. We know that muscles are made to move, stretch and support joints. They are not intended to create joint stability. This constant muscle strain makes it difficult for muscles to operate in the manner for which they intended. In turn, this strain creates pain within the body not only with physical activity, but with day to day activities as well.
DIAGNOSIS AND TREATMENT OPTIONS:
X-rays and CT scans are commonly used to help diagnose hip dysplasia. Your hip specialist will take these into consideration along with your MRI to give you a holistic idea of how your bony anatomy relates to soft tissue issues within and around the joints as well as how other ailments may relate. Keep in mind that while Physical therapy will not change your bony anatomy or cartilage damage, it can help to address the muscular deficits accompanying this diagnosis to help improve pain and daily function. Surgical intervention, a Periacetabular Osteotomy, may be a potential end result to help move forward.