Young Adult Hip Conditions #physiotalk Mon 9th July

Our chat on 9th July is guest hosted by @hipsterlife85  or M-J Sharp who blogs about her experiences at HipsterHip. The focus of the tweetchat is about young adult hip conditions mainly focussing on hip dysplasia.

She says

‘I am a student physiotherapist in the final year of my degree at Salford University, with an interest in young adult hip conditions.  I am coming at this from a ‘lay’ perspective stemming from my involvement with academics, clinicians, surgeons & other patients whom I am in contact with, and also from my own experience with a hip condition in young adulthood’.

Background

Hip dysplasia is a condition in which the acetabulum (hip socket) does not fully develop from birth or after a growth spurt in adolescence or young adulthood (Pun, 2016).  This means that the acetabulum is shallow or does not form a proper weight bearing surface over the femoral head.  Congenital cases are usually referred to as Developmental Dysplasia of the Hip (DDH) whereas cases in adolescents and young adults are referred to as Adolescent onset or Acetabular Dysplasia.

It is estimated that something between 0.5 – 5% of the population have hip dysplasia – that’s at least 1 in every 200 (Engesaeter et al, 2011; Pun, 2016).  It is on a spectrum, from a mildly shallow acetabulum, through to more severe dysplasia or even a dislocating hip.  It is currently unknown the exact prevalence of symptomatic hip dysplasia in young adults under 50.

The abnormal biomechanics of hip dysplasia can lead to the onset of secondary hip osteoarthritis at a much earlier age than usual, ultimately requiring a hip replacement at an early age (Wyles et al, 2017).  Pelvic Osteotomy (also called Periacetabular Osteotomy or PAO) is a surgery that reshapes the acetabulum to better cover the femoral head, aiming to delay the onset of OA and therefore delay THR (Coobs et al, 2015).  There is some evidence showing good survival rate in PAOs at 20 years (Steppacher et al, 2008).  Some can even get back into impact sports, some can’t or may choose lower-impact activities.  Hip-dysplasia

 

Those in the hip dysplasia community have a wide range of experiences. From prompt diagnosis and treatment in infancy or young adulthood, to delayed diagnoses, multiple surgeries and lifelong disability – and everything in between!

Pre-chat questions

Q1 What setting do you see young adult hip patients in and why are they referred?

Q2 What are you looking for in your assessment that suggests a diagnosis of hip dysplasia?

Q3 Do you refer for imaging or an orthopaedic opinion?

Q4 What is your approach in the management of patients with adult hip dysplasia?  What treatment modalities or specific areas do you target and why?

Q5 What do you find the biggest challenge when treating your young adults/adolescents with hip or hip related groin pain?  How do you think these can be overcome?

Q6 There is currently no recognised guidance or consensus on a treatment pathway for young adult patients with hip related pain.  If there was, what kinds of things do you think should be part of it?

Q7 How can we support each other to learn more about the best management of hip dysplasia in the adolescent or young adult?

Q8 How can we best support our patients pre- or post op or in the long term management of their hips?

Missed the chat?

Catch up with the transcript here

Chat resources

The International Hip Dysplasia Institute: ‘Adult Hip Dysplasia’

Clinical Update: Acetabular Dysplasia Frontline article

‘Young Adult Hip’ a surgeon’s perspective

Periacetabular Osteotomy (PAO)

My Hip Dysplasia Story – one young adult describes her journey to receiving a diagnosis of hip dysplasia, sadly not uncommon

Adult Hip Dysplasia a podcast

Dramatically Hip – a blog following one young adult’s experience with Hip Dysplasia

Happy Healthy Hippy – the experience of somebody with borderline Hip Dysplasia

The role of the Labrum in a Dysplastic Hip

Hip Dysplasia in the Young Adult

Peri-acetabular Osteotomy 20 year follow-up

The Natural History of Osteoarthritis in Patients with Hip Dysplasia & Impingement

Total Hip Replacement in young adults with hip dysplasia

 

References

Coobs, B. R., Xiong, A. & Clohisy, J. C. (2015) Contemporary Concepts in the Young Adult Hip Patient: Periacetabular Osteotomy for Hip Dysplasia, The Journal of Arthroplasty, 30. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25865812

Engesaeter, I., Lehmann, T., Laborie, L. B., Lie, S. A., Rosendahl, K & Engasaeter, L. B. (2011) Total Hip Replacement in young adults with hip dysplasia. Acta Orthopaedica, 82 (2). 149 – 154 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235283/

Nunley, R. M., Prather, H., Hunt, D., Schoenecker, P. L. & Clohisy, J. C. (2011) Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients. The Journal of Bone & Joint Surgery. 93-A (2).  Retrieved from https://insights.ovid.com/pubmed?pmid=21543683

Pun, S. (2016) Hip Dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia. Current Reviews in Musculoskeletal Medicine, 9 (4). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127949/

Steppacher, S. D., Tannast, M., Ganz, R. & Sienbenrock, K. A. (2008) Mean 20-year Followup of Bernese Periacetabular Osteotomy. Clinical Orthopaedics and Related Research, 466. 1633 – 1644. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505253/

Wyles, C. C., Heidenreich, M. J., Jeng, J., Larson, D. R., Trousdale, R. T. & Sierra, R. J. (2017) The John Charnley Award: Redefining the Natural History of Osteoarthritis in Patients with Hip Dysplasia & Impingement. Clinical Orthopaedics & Related Research, 475. 336 – 350. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5213917/

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