Preventing Adult Hip Arthritis in Adolescence

Acetabular dysplasia, a condition marked by a shallow hip socket, can lead to short-term difficulty when playing sports and being physically active, and can lead to long-term complications such as chronic pain, limited mobility, and early-onset osteoarthritis. Gillette Children’s orthopedic surgeon Alison Dittmer, MD, strongly advocates for early diagnosis and intervention for hip symptoms like pain, weakness, and muscle fatigue in teens. She says, “A full hip exam and timely treatment is a significant factor in preventing further joint deterioration and early-onset arthritis.” 

Gillette Children’s brings exceptional depth to hip and joint preservation care. While “hip preservation” is a widely used term, Gillette stands apart by offering a team of providers well versed in the full spectrum of nonsurgical and surgical treatments — including physical therapy, hip arthroscopy, periacetabular osteotomy (PAO), and complex osteotomies for femoral deformities. This breadth of experience allows for tailored surgical plans based on each patient’s anatomy and pathology, rather than relying solely on one approach to restore hip stability, maintain an active lifestyle, and support healthy joint aging.

Clinical presentation and background

Patients with hip dysplasia, and the often-underdiagnosed acetabular retroversion, present with mechanical symptoms before the onset of joint degeneration. Structural issues — such as a shallow acetabulum or poor femoral head coverage — lead to muscle fatigue or activity-induced muscle fatigue, altered gait mechanics, pain, and cumulative soft-tissue damage. Dr. Dittmer explains why fatigue is such a red flag for diagnosing hip dysplasia: “If the hip socket is not supporting the ball very well, the gluteus muscles — glute max and medius — are always firing, always on to help support the structural weakness of the joint. Eventually this leads to muscular fatigue, achy pain, and further mechanical dysfunction.” 

Gillette hip preservation providers see a huge range of goal-setting from patients when discussing their symptoms and diagnosis. Some patients come to the clinic as high-performance high school or college athletes looking to return to their sport, but others have goals surrounding their pain level, saying, “I don’t want to think about my hip every day,” or “I want to be able to just live my normal life.” 

Dr. Dittmer reports that some patients arrive in her clinic after initial misdiagnosis or prior unsuccessful arthroscopic procedures that have failed to address underlying instability. Hip arthroscopy can repair a labrum, but if the labrum is torn because the hip mechanics are bad and not addressed, hip arthroscopy is just a stopgap solution with little long-term success. “The key differentiator at Gillette is our ability to discern when labral tearing is secondary to socket insufficiency, rather than a primary soft tissue pathology,” says Dr. Dittmer. “We can offer better treatment outcomes through bony realignment rather than repeat arthroscopies.”

Intervention and surgical strategy

All intervention and treatment recommendations are based on condition severity and patient goals. In the case of hip dysplasia in adolescents, initial management could include physical therapy focused on gluteal and core strengthening supported by NSAIDs to optimize hip function in athletes and minimize pain. In specific cases, corticosteroid injections may help patients tolerate rehabilitation. 

Moving from nonsurgical to surgical recommendations, surgical care could include a periacetabular osteotomy or a femoral osteotomy to address structural insufficiency and restore joint integrity. For patients with accumulated intra-articular damage, hip arthroscopy may be performed concurrently to repair labral tears and debride cartilage. 

Gillette Children’s has many resources in advanced imaging, such as BoneMRI, which allows surgeons to use MRI-derived CT reconstructions to support patient-specific corrections in the OR. This imaging eliminates radiation exposure for adolescents — crucial for pre-childbearing patients.

Outcomes and recovery

The PAO procedure offers two key benefits: restoring joint mechanics — which lessens pain and improves function in the short term — and reducing long-term osteoarthritis risk. Studies reported in the Journal of Bone & Joint Surgery and Clinical Orthopaedics and Related Research offer more than 30 years of data supporting the long-term effectiveness of PAO in delaying — or entirely preventing — hip replacement.

While the benefits are clear, the road to recovery after a PAO can be extensive and include pain, discomfort, and mobility difficulties, especially in the first two weeks post-op. A typical recovery trajectory might look like this:

• First 2 weeks: Limited mobility with significant fatigue and assistance required
• Weeks 3–6: Gradual improvement; initiation of therapy
• Post-6 weeks: Crutch-free ambulation and strengthening
• 3+ months: Sport-specific training resumes
• 6–9 months: Return to preoperative athletic function.

A 2022 study in the Journal of Arthroscopic & Related Surgery showed an 80% return-to-sport rate two years post-PAO and arthroscopy in competitive youth athletes.

Real Gillette patient stories reinforce these time frames. Notable cases include college athletes returning to varsity-level play, dancers resuming intensive training, and teens reclaiming basic mobility and school attendance after years of hip-related setbacks. Though uncommon, Dr. Dittmer saw one young adult return to varsity diving just five and a half months after PAO. Others follow a more typical six-month time frame, like fast-pitch softball player Illyana Shepard, who had a notable recovery and sustained performance six and a half months after her surgery.

Provider reflections and practice implications

Gillette’s hip preservation program provides a depth of diagnostic insight and breadth of surgical intervention rarely matched in the region. While many orthopedic clinics offer limited hip arthroscopy, Gillette’s ability to recognize complex pathology and offer definitive correction makes it a critical referral destination — especially for teens and young adults misdiagnosed or underserved elsewhere.

As structural hip pathologies, including acetabular dysplasia and retroversion, gain increased clinical recognition, Gillette remains a leader in holistic, evidence-based, and goal-oriented care — empowering young patients to reclaim mobility, identity, and long-term joint health. 

Refer a patient to Dr. Dittmer at gillettechildrens.org/referral