Acetabular Retroversion

Acetabular retroversion means that the hip socket is shallow. This causes instability of the hip joint at the posterior aspect. This is a congenital anomaly or develops during growth.

A fully developed hip joint can be compared to a soup bowl and a tennis ball. The tennis ball sits firmly in the bowl with only a little play, just enough to move smoothly. With dysplasia, it is different. It is as if you place the tennis ball on a soup plate: in this case, the ball has more space and less stability.

This means that the femoral head is less well supported by the socket, which can lead to a less stable joint. This reduced stability can eventually cause symptoms such as pain or wear and tear of the hip joint.

People with hip dysplasia often experience pain during activities that stress the hip, such as:

• Strolling
• Walking
• Prolonged sitting
• Prolonged standing
• High-impact sports

This pain is often accompanied by back pain or back complaints, as hip stability can also affect the spine and the resulting load. Overloading of the hip joint can lead to compensatory postures and movements, which can put additional pressure on the back.

Why does hip dysplasia cause pain?

Hip dysplasia is a condition that can be present at birth, but symptoms often only become noticeable later. This is because the body adapts and the load on the joint increases as you age.

Your body tries to give the hip extra stability by using the labrum. This is a ring-shaped structure at the rim of the hip socket, which can be compared to a suction cup. The labrum has two important functions:

• Stability: The labrum essentially forms a cup that helps to keep the femoral head firmly in the hip socket.
• Shock absorption: It acts as a shock absorber that absorbs forces on the hip joint, for example, during walking or running.

However, in hip dysplasia, the labrum has to work much harder to stabilize the femoral head, often 4 to 11 times harder. This increased effort can make the labrum vulnerable, and if it becomes overloaded, it can tear. Such a tear, also known as a labral tear, can cause pain and a feeling of instability, sometimes accompanied by a “clicking” of the hip.

Important to note: a labral tear is not always serious. Research shows that 54% of people without hip pain have a labral tear visible on medical imaging.

Because the labrum cannot always provide sufficient support, the muscles around the hip play a crucial role. Especially the gluteal muscles and the muscles at the front of the hip are essential to keep the femoral head stable in the socket and prevent further overload. Targeted muscle-strengthening exercises can be immensely helpful here.

However, with the right treatment and self-care measures, symptoms can often be well managed, and a high-quality, active life can be maintained. If discomfort persists, an injection can be administered, or surgery may be necessary.

Several surgical procedures are available for treating hip dysplasia, depending on the degree of dysplasia:

• Peri-acetabular osteotomy
• Arthroscopy (if hip dysplasia is very mild)
• Total hip arthroplasty (if there is also a severe form of osteoarthritis)

We will discuss together which treatment option is most suitable based on your specific situation and needs.