Hip, hip, hooray! Athletes don’t have to call it a day

Developmental hip dysplasia (DHD) is a disorder associated with anomalies in the articular and periarticular anatomy of the hip. The associated structural abnormalities result in hip instability, capsular laxity, and abnormal growth of the acetabulum^(1,2). Subsequently, the biomechanics of the hip are affected. The multifactorial etiology includes genetic, environmental, and mechanical risk factors⁽²⁾.

Developmental hip dysplasia is common in sports such as ballet, gymnastics, figure skating, competitive cheerleading, and wrestling^(3,4). Athletes who participate in these sports use their hips in a supraphysiologic, mechanically complex manner. From a performance perspective, increased joint range of motion and flexibility associated with DHD is a favorable attribute until joint deterioration occurs⁽³⁾. Repetitive movement in these extreme ranges of motion results in compensatory osseous and muscular pathology^(1,3,5). Whether innate or acquired, these athletes have some hypermobility predisposing them to hip impingement or instability^(4,5). Athletes with inherent generalized hyperlaxity are at increased risk of injury and may require longer recovery times to return to performance (RTP). If left untreated, symptomatic DHD leads to early-onset osteoarthritis. Both nonoperative and operative treatments (arthroscopic and open) have an essential role in returning athletes to their preoperative performance levels^(1,3,6).

Anatomy and pathology

The hip is a synovial, ball-and-socket joint formed by the femoral head that fits into the acetabulum. The development of the acetabulum and femoral head is closely interrelated, and interference during infancy or early childhood affects the congruency of these structures leading to DHD^(1,4). More specifically, DHD is a disorder in which the abnormal development of the hip results in a shallow acetabulum with limited anterior and lateral cover of the femoral head (see figure 1)⁽²⁾.