A teenager complains of a sore hip after netball, dance or running. It's put down to a groin strain, tight hip flexors or growing pains. They rest, stretch, try some exercises. It settles for a while, then comes back. And again.
For some young people, that frustrating cycle has a cause that's easy to overlook: hip dysplasia.
Hip dysplasia is often thought of as something checked for in babies. But it can also show up for the first time in adolescence or early adulthood, and it frequently goes undiagnosed for years. Here's why that happens, what to look out for, and why getting the diagnosis early matters so much.
What is hip dysplasia?
Your hip is a ball-and-socket joint. The ball is the top of the thigh bone, and the socket is part of the pelvis.
In hip dysplasia, the socket is too shallow and doesn't fully cover the ball. That means the forces going through the hip are concentrated on a smaller area, placing extra strain on the cartilage, the labrum (a rim of cartilage around the socket) and the muscles that work to stabilise the joint.
Over time, that extra strain can lead to pain, labral tears and, eventually, early osteoarthritis.
"But weren't they checked as a baby?"
Yes, and that's part of the reason dysplasia in teenagers can be missed.
Babies in Australia are routinely examined for developmental dysplasia of the hip (DDH), and those with risk factors may have an ultrasound. These checks are very good at picking up hips that are unstable or dislocated.
But a hip can be stable at birth and still have a socket that's slightly shallow. Some forms of dysplasia only become apparent as the skeleton matures, and research describes a group of people whose dysplasia appears in adolescence despite having stable hips as babies. A normal newborn check doesn't rule out dysplasia later in life.
Why it goes undiagnosed for so long
Research shows that delays in diagnosis are very common. In a UK study of young adults with hip dysplasia, 75 of 97 participants experienced a delayed diagnosis, with an average delay of eight years. Another study found that the average time from first seeing a GP to being reviewed at a specialist young adult hip clinic was over 40 months.
There are a few reasons this happens.
The symptoms look like other, more common problems
Hip dysplasia often causes pain in the groin, the front of the hip or the side of the hip. These are the same areas affected by common sports injuries, so it's easy to label the pain as:
A groin or hip flexor strain
Tight muscles or poor flexibility
Tendinopathy or bursitis
Growing pains
Lower back problems
And because the muscles around a dysplastic hip are working overtime to stabilise it, they often are sore and tight. Treating the muscles can help for a while, but it doesn't address the underlying shape of the joint.
Many teens with dysplasia are very flexible
A shallow socket can allow more movement than usual. Many young people with dysplasia are naturally flexible and do well in dance, gymnastics, cheerleading or similar activities. That flexibility can mask the problem until pain develops.
Symptoms come and go
Pain often flares with activity and settles with rest. When it eases, it's natural to assume the problem has resolved.
It needs the right imaging
Hip dysplasia is diagnosed with an X-ray of the pelvis, taken and measured correctly. One key measurement, the lateral centre-edge angle, shows how well the socket covers the ball. Specialist literature describes an angle below 20 degrees as dysplasia, with values a little above that considered borderline.
If no X-ray is taken, or if the measurements aren't looked at specifically, mild or borderline dysplasia can easily be overlooked.
Warning signs to look out for
Hip dysplasia should be considered in a teenager or young adult with hip pain, especially if:
Pain is in the groin, front or side of the hip, and keeps coming back
Pain is worse with walking, running, standing for long periods or sport
There's clicking, catching, locking or giving way in the hip
The hip feels tired or achy after activity
There's a limp, especially later in the day or after sport
Pain hasn't resolved despite rest, stretching or treatment for a muscle strain
They're female, or there's a family history of hip dysplasia or early hip problems
They were breech at birth or had treatment for hip problems as a baby
They're very flexible or have generalised joint hypermobility
Why early diagnosis matters
This is the most important part.
When hip dysplasia is picked up before significant joint damage has occurred, young people may be candidates for joint-preserving treatment. Depending on the severity, this might include an exercise-based program to strengthen and support the hip, or a specialised surgery called a periacetabular osteotomy (PAO), which repositions the socket to better cover the ball. Research in adolescents with borderline dysplasia has reported substantial improvements in pain and function after PAO.
When diagnosis is delayed, cartilage damage and arthritis can develop. Research has found that people with longer referral delays had worse function, more advanced arthritis on X-ray, and were more likely to need a hip replacement rather than joint-preserving surgery.
In short, the earlier it's found, the more options there are.
Other hip conditions in teenagers to know about
Hip dysplasia isn't the only cause of hip pain in young people. A few others are worth knowing about:
Slipped capital femoral epiphysis (SCFE): the growth plate at the top of the thigh bone slips. It's most common in early adolescence and often causes a limp, hip, thigh or knee pain, and a foot that turns outwards. This needs urgent medical assessment. A child or teenager with these symptoms should avoid putting weight on the leg and be seen at an emergency department or by their GP the same day.
Femoroacetabular impingement (FAI): extra bone on the ball or socket causes them to pinch during movement, often in active teens
Labral tears: often associated with dysplasia or FAI, causing clicking, catching and groin pain
Apophyseal injuries: strains or avulsions where tendons attach to growing bone, common in sprinting and kicking sports
It's worth knowing that hip problems in children and teenagers can sometimes be felt mainly in the knee. Knee pain without an obvious knee injury should prompt a check of the hip.
When to get it checked
See a health professional if a teenager has:
Hip or groin pain lasting more than a few weeks, or that keeps returning
A limp
Clicking, catching or locking in the hip
Pain that's limiting sport, school or daily activities
Knee pain without a clear knee injury
Seek urgent medical care for sudden severe hip pain, inability to bear weight, a limp with fever, or any symptoms suggesting SCFE.
How we can help
At Epoch Health, our chiropractors take hip pain in young people seriously. We'll:
Take a detailed history, including sport, flexibility, family history and any hip problems as a baby
Assess how the hip and surrounding muscles move and respond
Look for the warning signs of hip dysplasia and other conditions that need further investigation
Arrange or recommend appropriate imaging, or refer to your GP, when it's needed
Coordinate with your GP and refer to a specialist hip surgeon if dysplasia or another structural problem is suspected
Support ongoing management, including advice on activity and a tailored home exercise program, alongside any specialist care
If your teenager's hip pain keeps coming back, it's worth asking the question: could it be the hip joint itself?
Book an appointment at our Dundas Valley or Telopea clinic: epochhealth.net.au/bookings
This article is general information only and isn't a substitute for personalised health advice. If your child or teenager has sudden hip pain, can't bear weight, or has a limp with fever, seek urgent medical care.
References
Gambling TS, Long A. Psycho-social impact of developmental dysplasia of the hip and of differential access to early diagnosis and treatment: a narrative study of young adults. SAGE Open Medicine. 2019;7.
Kennedy JW, et al. Delays in diagnosis are associated with poorer outcomes in adult hip dysplasia. Scottish Medical Journal. 2017.
Millis MB, McClincy M. Periacetabular osteotomy to treat residual dysplasia in adolescents and young adults: indications, complications, results. Journal of Children's Orthopaedics. 2018;12(4):349–357.
Swarup I, Zaltz I, Robustelli S, Sink E. Outcomes of periacetabular osteotomy for borderline hip dysplasia in adolescent patients. Journal of Hip Preservation Surgery. 2020;7(2):249–255.