Meet the young woman whose hips are already falling apart
02:49 GMT, 27 November 2012
Next spring, I am undergoing major hip surgery. The thought of three months on crutches and six months without sport fills me with dread, but I hope the operation will arrest the rapid onset of pain I have in my right hip — and stave off the need for a full hip replacement.
I am only 37, hardly the usual age for arthritic wear and tear. But the crippling pain is almost unbearable at times, and without an operation I could soon find myself unable to walk, as just a few steps could leave me in agony.
Six months ago, I was diagnosed with developmental hip dysplasia (DDH), which means my hip socket is too shallow for the ball of the hip joint. This causes the bones to rub awkwardly together, instead of fitting snugly.
Facing up to surgery: Abigail suffers from hip dysplasia, which impacts on day to day activities
For a condition most people won’t have heard of, hip dysplasia is surprisingly common. One authoritative Danish study found that 4 per cent of adults have it.
Worryingly, it invariably leads to arthritis. Because the hip sockets are shallow, people with hip dysplasia develop extra wear and tear in their joints.
Unfortunately, this can often go undetected until osteoarthritis has set in, and a full hip replacement is needed.
Around 40 per cent of the 75,000 people who have hip replacements each year in the UK have underlying signs of dysplasia.
Around 80 per cent of those affected are women. Symptoms are typically groin pain radiating to the knee, and a sensation that the hip is locking.
However, many people who have it display no symptoms, explains Johan Witt, consultant orthopaedic and trauma surgeon at University College London, and an expert in the condition.
Despite a lack of symptoms, they will inevitably develop arthritis, he says.
Usually the symptoms, if there are any, appear between the ages of 20 and 40. The pain is caused by the protective cartilage in the joint being pinched and damage by the bones rubbing together. Doctors are still unsure why some people develop symptoms, and others don’t.
I had no idea anything was wrong with my hips until two years ago, when I injured my knee in a cycling accident and my left leg was in a brace for six weeks.
I slipped in the bathroom and fell hard on my right hip, which made a sickening crunching sound. This left me immobile and breathless on the floor, as searing pain shot from my groin to my toes.
Since then, that hip has ‘clicked’ — as if the socket is catching — two, maybe three times a week: when I get out of the car, move my leg in bed, or stoop to pick up something off the floor. This is accompanied by the sensation of a hot poker being jabbed in my groin.
The rest of the time I have a dull ache down my right leg and in the hip joint, and discomfort sitting on a chair or in a car and lying in bed. Worst of all, it is starting to interfere with sport — my number one pleasure in life.
Hip dysplasia is a well-recognised problem in babies
Hip dysplasia is a well-recognised problem in babies, and if it is picked up at this point the child may be treated using splints to hold the ball in the socket so both develop normally. Some children may need to undergo surgery.
Adults with symptoms in later life are unlikely to have shown abnormalities at birth.
In my case, the injury to my hip aggravated the condition and triggered my symptoms, but it can come on simply with daily activity and exercise.
I knew nothing of this until just a few months ago. When I started to rebuild my fitness after the knee accident in 2010, I just noticed my right hip became increasingly problematic and hurt when I walked or moved in a particular way.
I had treatment from a sports physiotherapist which eased the pain for a while, but it soon returned. Earlier this year, he suggested I consult my GP in case I had a tear or chip in the socket.
In April, I was referred to an orthopaedic surgeon, Professor Nicholas Clarke in Southampton — one of the founding members of the International Hip Dysplasia Institute. After a quick manipulation and X-ray, he instantly diagnosed hip dysplasia in both hips (most patients find both are affected), although it’s more pronounced in my right socket.
‘Treatment is instigated by pain,’ Professor Clarke told me. ‘Once the pain becomes more extensive while walking and sitting, we intervene with surgery.’
There are two main forms of surgery used in DDH — pelvic osteotomy (before the onset of osteoarthritis) and hip replacement (after osteoarthritis has set in). At my age, with no real sign of wear and tear, pelvic osteotomy — reconstructing the hip socket so it covers more of the ball of the hip joint, then screwing it back in place, was the best option.
But the idea of such major surgery, with three months sitting still while I recovered — and no idea of what level of activity I would be able to return to when I did — seemed appalling to me.
A month on, the pain in my hip had worsened considerably. I sought a second opinion from Johan Witt in London, desperate to hear there was a non-surgical solution — but he repeated Professor Clarke’s prognosis.
‘When there’s a structural problem that prevents the joint from functioning properly, you need a structural solution,’ he says.
He added that non-surgical options would have little, if any, effect. ‘Doing Pilates and physiotherapy exercises won’t allow you to run again, or change the underlying problem.’
Annick Hollins, 50, underwent a double osteotomy in 2009 after suffering problems with her hip in 2008, following her sixth consecutive London Marathon. ‘I took up running at 40, but had studied ballet and gymnastics all through my childhood and teens, and never noticed a thing,’ says the mother-of-three from Sussex.
Suddenly, she developed a ‘niggling’ pain in her left hip, which turned into a deep ache running down her left leg. One morning Annick collapsed in the shower.
‘It was a twang, like someone had stabbed me with a red-hot poker in my groin,’ she explains.
She saw two consultants, the first of whom diagnosed a tendon problem, and Annick was finally referred to Mr Witt in March 2009. ‘Both my hips were significantly shallow, so the only option was a pelvic osteotomy,’ she explains. ‘My brain couldn’t get round the fact I needed such major surgery, as I wasn’t in constant pain and had always been so fit.
‘But I was relieved there was a treatment available, and I was told it works best for younger adults because their pelvises can adapt to the change better.’
In May 2009, Annick underwent surgery first on her right hip — and returned to fitness enough to walk the Great South Run in October 2009. She had the second operation, on her left hip, three days after completing the event.
Post-operative care includes up to a week in hospital, hydrotherapy and extensive physiotherapy. Two years on, Annick is slowly returning to running.
‘I was very determined, and compared to other people I got away very lightly. Some people been in pain all their lives, or have had to undergo full hip replacements as young as 17.’
Although Annick and I are very active, Mr Witt says hip dysplasia is not caused by exercise, though it can exacerbate the symptoms.
‘The condition is completely independent of anything the patient does,’ he says. He has seen some patients whose pain started simply while walking to work.
So how can you tell if your niggling hip pain is dysplasia
‘The typical story is someone takes themselves to a physiotherapist for groin pain, has treatment, stops sport, feels better, starts sport again and the pain comes back,’ warns Mr Witt.
‘Recurrent problems should not be ignored. A normal hip can take high levels of activity, so if you can’t run normally as a 20 or 30-year-old, you may need to see a doctor.’
After much soul-searching, I decided to have the operation next February, hoping I will be up and about again by the summer. I will have to take every day, and each activity, one step at a time.
For more information, contact hipdysplasia.org or steps-charity.org.uk, 01925 750271.