Developmental Dysplasia of the Hip (DDH): Pain Across Lifespan, Symptoms, and Management

Is DDH painful?

Yes, Developmental Dysplasia of the Hip (DDH) can be painful, though the onset, type, and severity of pain vary significantly with age, the degree of hip instability, and the presence of secondary complications such as osteoarthritis.

Understanding Developmental Dysplasia of the Hip (DDH)

Developmental Dysplasia of the Hip (DDH), formerly known as congenital dislocation of the hip, is a condition where the hip joint has not formed properly. This can range from a shallow acetabulum (hip socket) to a completely dislocated femoral head (ball of the thigh bone) from the socket. The hip joint is a ball-and-socket joint, and its stability relies on the proper congruency and depth of the socket embracing the ball. When this alignment is compromised, it can lead to abnormal mechanics, increased stress on joint tissues, and, ultimately, pain.

DDH and Pain Across the Lifespan

The experience of pain in individuals with DDH is highly dependent on their age and the progression of the condition.

• Infancy and Childhood: In infants and young children, DDH is often painless or causes only subtle discomfort. This is primarily because their bones are still largely cartilaginous, and they are not yet engaging in high-impact, weight-bearing activities that stress the joint. Signs of DDH in this age group are usually non-painful, such as:

  • Asymmetry in thigh folds.
  • Limited range of motion in one hip.
  • A difference in leg length.
  • A "clunk" sound or feeling during specific hip maneuvers (Ortolani or Barlow signs). If pain is present, it might manifest as fussiness or reluctance to move the affected leg, but this is less common than in older individuals.

• Adolescence and Early Adulthood: As individuals with undiagnosed or untreated DDH grow older and become more active, the likelihood of experiencing pain significantly increases. The increased forces of weight-bearing, running, and jumping place greater stress on the abnormally formed joint. Pain in this stage is often due to:

  • Labral tears: The labrum, a rim of cartilage around the hip socket, can tear due to instability or impingement.
  • Cartilage wear: Abnormal mechanics lead to premature wear of the articular cartilage.
  • Hip impingement (FAI): The misshapen bones can rub against each other during movement, causing pain.
  • Instability: A feeling of the hip giving way or "clunking" can be painful. Pain is typically felt in the groin, but can also radiate to the side of the hip, buttock, or even down the thigh. It is often exacerbated by physical activity and prolonged standing or walking.

• Adulthood (Untreated or Progressive DDH): For adults who have lived with untreated or progressively worsening DDH, pain becomes a prominent and often debilitating symptom. The primary cause of severe pain in adult DDH is the accelerated development of osteoarthritis (OA). The chronic abnormal forces and wear within the hip joint lead to significant degeneration of the articular cartilage, bone-on-bone friction, and the formation of bone spurs (osteophytes). Symptoms at this stage include:

  • Chronic, deep aching pain in the groin, outer hip, or buttock.
  • Stiffness and reduced range of motion, particularly after periods of rest.
  • Pain with weight-bearing activities like walking, climbing stairs, or standing for long periods.
  • Limping (Trendelenburg gait) due to pain and muscle weakness. The pain can significantly impact daily activities, exercise capacity, and overall quality of life.

Factors Influencing Pain Severity in DDH

Several factors contribute to how much pain an individual with DDH experiences:

• Severity of Dysplasia: More severe forms of DDH, involving greater shallowing of the socket or significant subluxation/dislocation, are more likely to lead to earlier and more severe pain.
• Age at Diagnosis and Treatment: Early diagnosis and appropriate treatment (e.g., bracing, casting, or early surgery) can often prevent or significantly delay the onset of pain and the development of osteoarthritis.
• Activity Level: Individuals who engage in high-impact sports or occupations that involve repetitive hip loading may experience pain sooner and more intensely.
• Presence of Complications: Secondary conditions like labral tears, femoroacetabular impingement (FAI), or advanced osteoarthritis directly contribute to pain.
• Compensatory Mechanisms: The body may try to compensate for hip instability or pain by altering gait or posture, which can lead to pain in other areas like the back or knees.

Common Pain Characteristics and Locations

Pain associated with DDH typically presents with the following characteristics:

• Location: Most commonly experienced in the groin region, but can also be felt in the lateral hip, buttock, or referred down to the thigh or knee.
• Nature: Often described as a deep ache, sharp pain with certain movements, or a dull throb.
• Triggers: Worsens with physical activity (walking, running, standing for long periods), pivoting movements, or getting up from a seated position.
• Mechanical Symptoms: May be accompanied by clicking, popping, catching, or a feeling of instability in the hip joint.

When to Seek Medical Attention

If you or someone you know experiences persistent hip pain, especially if accompanied by:

• A noticeable limp or change in gait.
• Limited hip mobility or stiffness.
• Audible clicking, catching, or grinding in the hip.
• Difficulty performing daily activities due to hip pain.

For infants and young children, any concerns about hip asymmetry, limited movement, or unusual leg positions should prompt immediate medical evaluation. Early diagnosis of DDH is crucial for effective management and preventing long-term pain and disability.

Management and Treatment Approaches for DDH-Related Pain

The management of DDH-related pain depends on the individual's age, the severity of the dysplasia, and the presence of any secondary complications.

• Conservative Management:

  • Physical Therapy: Focuses on strengthening the muscles around the hip (gluteals, core), improving hip stability, restoring range of motion, and correcting gait abnormalities.
  • Activity Modification: Avoiding high-impact activities that exacerbate pain and opting for low-impact exercises (swimming, cycling) can help manage symptoms.
  • Pain Management: Over-the-counter pain relievers (NSAIDs), ice, and heat may provide temporary relief.
  • Assistive Devices: Crutches or canes can reduce load on the hip during painful flares.

• Surgical Interventions: When conservative measures fail or in cases of significant dysplasia, surgical options may be considered:

  • Periacetabular Osteotomy (PAO): A complex procedure typically performed in adolescents and young adults, where the hip socket is cut and reoriented to provide better coverage for the femoral head, thereby improving joint mechanics and preventing further degeneration.
  • Arthroscopy: May be used to address specific issues like labral tears or impingement in less severe cases.
  • Total Hip Arthroplasty (THA): For older adults with advanced osteoarthritis due to DDH, hip replacement surgery is often the most effective solution for alleviating pain and restoring function.

Conclusion

In summary, while DDH may not always be painful in infancy, it is a significant cause of hip pain in adolescence and adulthood, particularly if left undiagnosed or untreated. The pain arises from abnormal joint mechanics, leading to premature wear, instability, labral tears, and ultimately, debilitating osteoarthritis. Early diagnosis, appropriate intervention, and a comprehensive management plan, often involving both conservative and potentially surgical approaches, are critical for minimizing pain, preserving hip function, and improving the long-term quality of life for individuals with Developmental Dysplasia of the Hip.