She was 25 and needed a hip replacement — how can we stop this happening?
Not the start to the week that I wanted.
One of my patients on Monday morning was just 25 years old. Chronic hip pain for over four years. Seen by multiple clinicians. Not picked up.
Hip dysplasia. Missed. Now progressed to severe osteoarthritis.
She’s missed the window for periacetabular osteotomy (PAO) surgery. Now she’s waiting for a hip replacement.
Twenty-five.
This case isn’t unique. And that’s precisely the problem. Kennedy et al. [1] found that the mean time from a patient presenting to their GP to finally being seen at a specialist young adult hip clinic was over 40 months. Those with delayed referrals had worse functional scores, higher radiological osteoarthritis grades, and were significantly more likely to require total hip arthroplasty rather than the joint-preserving periacetabular osteotomy that could have changed the trajectory of their condition entirely.
Gambling and Long [2] explored the psychosocial impact of this diagnostic delay in a study of 97 young adults with hip dysplasia. Seventy-five of them experienced a delayed diagnosis, with an average delay of eight years. Eight years of being told it’s muscular, it’s postural, it’ll settle with exercises. These patients became progressively more debilitated, experienced chronic pain, and reported a profound impact on their quality of life and psychological wellbeing.
As frontline MSK clinicians, we are often the first point of contact for these patients. We have the opportunity to change this. But only if we know what we’re looking for.
Here are five clinical pointers that should raise your index of suspicion for hip dysplasia, and the reasoning behind each one.
