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Related Experiment Video

Updated: Apr 29, 2026

In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
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Does Deformity Severity Dictate Which Side Initially Develops Symptoms in Bilaterally Dysplastic Hips?

Madison M Wissman1, Jiayi Sun2, Benjamin E Northrup3

  • 1Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|April 28, 2026
PubMed
Summary

Acetabular deformities, not femoral ones, are linked to pain asymmetry in developmental dysplasia of the hip (DDH). This finding helps understand DDH progression and guides interventions for better joint health.

Keywords:
acetabular deformitiesdeformity severitydevelopmental dysplasia of the hiphip geometrysymptom asymmetry

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Area of Science:

  • Orthopedics
  • Biomedical Engineering
  • Radiology

Background:

  • Developmental dysplasia of the hip (DDH) often presents with bilateral deformities but asymmetric symptoms, a phenomenon not fully understood.
  • Understanding the relationship between deformity severity and symptom asymmetry is crucial for effective patient management.

Purpose of the Study:

  • To investigate the correlation between hip deformity severity and symptom asymmetry in patients with bilateral DDH.
  • To determine whether acetabular or femoral deformities are more closely associated with symptomatic hip presentation.

Main Methods:

  • Hip geometry was measured in 230 patients using lateral center-edge angle (LCEA), acetabular inclination, neck-shaft angle, alpha angle, and femoral version.
  • Measurements were compared between initially symptomatic hips and contralateral hips.
  • Patients were categorized based on the severity of side-to-side LCEA differences and activity levels were assessed.

Main Results:

  • Symptomatic hips exhibited more severe acetabular deformities (LCEA and acetabular inclination) in 80% of subjects (p < 0.001).
  • A more severe neck-shaft angle was observed in symptomatic hips for most patients (p = 0.003), but with a small effect size.
  • No significant difference in activity levels was found between patients with more deformed symptomatic hips versus those with more deformed contralateral hips.

Conclusions:

  • Acetabular deformities appear to be the primary driver of asymmetric symptom development in bilateral DDH, more so than femoral deformities.
  • Self-reported activity levels did not correlate with symptom asymmetry, suggesting other factors may be involved.
  • These findings enhance understanding of DDH progression and symptom onset, informing targeted interventions for pain reduction and long-term joint health.