Hip dysplasia
November 7, 2010 | 20,00 EUR | answered by Dr. med. Olaf Stephan
Good evening,
I am 30 years old and female. For about 3 months (this year) I had almost daily pain in my left hip and pelvis, and severe pain when walking. I went to see a general practitioner who prescribed an x-ray for me. I was then referred to an orthopedic specialist who told me that I have a pronounced hip dysplasia, and he said that the pain is caused by the tendons and muscles. He prescribed me 8 sessions of physiotherapy and an orthopedic insole for my shoes, 0.6 cm thick.
He also x-rayed my right hip and said that the hip dysplasia on that side is even worse, but the cartilage on both sides is still normal. I have been pain-free for the last 3 months, but it is slowly starting to hurt again, not daily but quite irregularly, mostly when I walk my dog or when I work several days in a row. I stand and walk for 9 hours daily (I work in the healthcare sector).
What can I do if the pain gets worse again? The orthopedic specialist said that surgery is not necessary at the moment, as the cartilage is intact. Thank you for your response.
Kind regards.
Dear inquirer,
Of course, from a distance and without knowledge of the X-ray findings, I cannot provide an accurate assessment of the degree and severity of the bilateral hip dysplasia recently diagnosed in you. However, since the changes were only detected in you relatively late and apparently improved after a relatively short period of therapy, I assume there are still minor bony changes. Additionally, there is a leg length difference of 0.6 cm, which has been compensated for with an insole. Over time, dysplastic joint changes typically lead to accelerated wear and tear due to unilateral loading (so-called secondary arthrosis), but these are not yet radiologically detectable according to your treating orthopedic surgeon. Therefore, surgery is currently not under consideration for you, and therapy should continue to be purely conservative in the near future. Therefore, physiotherapy, possibly specific therapeutic exercises, postural exercises, compensatory sports, and regular wearing of orthopedic insoles (which should be regularly checked and, if necessary, replaced in the medium term) are the focus of therapy. Medications can support treatment by administering nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac, or indomethacin (depending on tolerability and efficacy), which are effective when short-term pain occurs. However, your occupational stress in the nursing sector where lifting heavy loads and problematic postures are often necessary when working at the bedside is a bit complicated in this context. Therefore, a change of workplace, up to occupational disability or reduced work capacity (accident insurance), may be necessary. I would like to mention that due to imbalances in the skeletal axis and associated misalignments, joint problems can also arise in the adjacent joints (knee joints and lumbar spine) due to your joint issues. A precise diagnosis of the hip joints, pelvis, and lumbar spine can be very informative through MRI (which does not involve radiation exposure, as the image is created by magnetic fields), and the orthopedic surgeon or primary care physician may refer you if necessary. Best regards, O. Stephan.
