Hip Dysplasia: What You Need to Know (and What Doctors Won't Tell You)

If you have hip pain, someone may have told you that it's from hip dysplasia. In this article, we'll look at what hip dysplasia is, what the research says about it, and where exercise fits into the picture.

If you're trying to understand your hip pain and how it relates to hip dysplasia, read on for a research-based overview — and a few things worth bringing up with your physician or surgeon.

I'm a corrective exercise and orthopedic exercise specialist, not a physician. Nothing in this article is medical advice or a recommendation for or against any medical treatment, including surgery. It's a summary of published research plus my perspective on the exercise side of hip health. Please talk with your physician or orthopedic surgeon about what's right for your specific situation.

Article Summary

• Hip dysplasia, or shallow hip sockets, is common in the asymptomatic population.
• There's no established test to determine whether dysplasia seen on an X-ray is the cause of a specific person's hip pain.
• Several long-term, large-scale studies have found no clear relationship between hip dysplasia, hip pain, and hip arthritis.
• Long-term studies show that periacetabular osteotomy (PAO) tends to reduce hip range of motion, with more mixed evidence on its effect on pain over time.
• In one 30-year follow-up study, more than 70% of PAO patients showed progressive changes in their hips over that period, and more than half eventually had a full hip replacement. This is a single long-term study, and surgical techniques and patient selection have evolved since then — it's worth discussing with your surgeon directly.

You can watch the summary of this article in this video on hip dysplasia 

What Is Hip Dysplasia?

In short, it's when the hip socket is considered shallower than typical. This shallowness is often discussed as a factor in hip hypermobility, and some surgeons consider it a risk factor for hip pain and hip osteoarthritis, though as we'll see below, the research on that relationship is mixed.

The most common surgical treatment offered is PAO (periacetabular osteotomy). We'll look at the outcome research on PAO later in the article. 

How Common Is Hip Dysplasia?

Hip dysplasia shows up often in people who have no symptoms at all. This is worth keeping in mind as we look at the research on dysplasia and hip pain. 

A paper published in 2010 from Denmark found that 4.3% of men and 3.6% of women with no symptoms had hip dysplasia.

A larger systematic review published in 2024 found 3.8% in females and 2.7% in males. 

In 19-year-old Norwegians, prevalence ranged from 1.7–20% depending on how dysplasia was defined, according to a 2013 study.

In Asian populations, asymptomatic hip dysplasia appears more prevalent. A Korean study found a prevalence of 12.8 to 15% (depending on which metrics were used). 

In a Japanese study on the elderly, nearly 30% had hip dysplasia, with no correlation found to hip osteoarthritis in that study. 

In short, hip dysplasia shows up quite often even in people with no symptoms at all. 

Does Hip Dysplasia Cause Hip Pain and Hip Osteoarthritis?

As noted above, dysplasia and an absence of symptoms often go together. If there were a strong, consistent link between dysplasia and hip pain, we might expect to see it show up more clearly in populations with higher rates of asymptomatic dysplasia, like some of the Asian population studies above — and the data on that isn't clear-cut.

Is there a way to confirm that dysplasia specifically is the cause of a given person's hip pain?

Based on the current research, there's no established test that can confirm this for an individual. Imaging can show dysplasia, but it can't tell you whether that's what's driving your particular pain. This is genuinely a question for your physician or surgeon, who can weigh your full clinical picture — it's not something a research summary like this one can answer for you. 

What does the research say about osteoarthritis specifically? 

Some surgeons and older papers describe a strong link between hip dysplasia and the development of hip arthritis. For example, this 2004 paper reports a strong correlation between hip dysplasia and hip arthritis. 

Other, more recent studies complicate that picture.

A 2005 study examined the relationship between dysplasia, joint-space width, and hip pain, following volunteers with dysplasia alongside a control group for 10 years. The researchers "found no significant differences in the reduction of the joint space width at follow-up between subjects with dysplasia and the control subjects nor in self-reported pain in the hip."

In the 2010 Danish study referenced earlier, researchers found "Acetabular dysplasia and the subject's sex were not found to be significant risk factors for the development of hip osteoarthritis."

And in a study on senior-age athletes published in 2016, researchers reported that "radiographic findings of DDH (dysplasia) were not predictive of OA (osteoarthritis)."

Key points: hip dysplasia is common in people with no symptoms, and multiple studies — including in senior-age athletes — have found no clear link between dysplasia and the later development of osteoarthritis. Other studies disagree. This is an area of genuine ongoing debate in the orthopedic research, not a settled question. 

What Does the Research Say About Surgery for Hip Dysplasia?

If you've been diagnosed with hip dysplasia, periacetabular osteotomy (PAO) is the most commonly recommended surgical treatment. 

PAO was developed in 1984 by Dr. Reinhold Ganz, with the technique published in 1987, launching a new field of hip preservation surgery. 

It's a substantial procedure: the surgeon cuts sections of the pelvis to reorient the acetabulum, then stabilizes the new position with screws. 

What does the outcome research actually show?

A 2024 paper analyzed data from 62 studies on surgery for hip dysplasia, applying the GRADE system (Grades of Recommendation, Assessment, Development and Evaluation) to rate the strength of evidence behind common claims about PAO outcomes. 

Two findings from that analysis are worth highlighting.

First, the certainty behind claims that surgery meaningfully helps hip dysplasia is rated low by GRADE standards. The authors write: "The improvements found across all subgroups from pre- to post-PAO surgery provide low level certainty that pain, ADL (activities of daily living), QOL (quality of life), sport and recreation, and symptoms improve following surgery. Despite the large magnitude of effect found, risk of bias of studies and inconsistency in data means the GRADE certainty rating remains at low." 

Second, patients generally don't return to the same function level as people without dysplasia. From the conclusion: "Adults with DDH (hip dysplasia) undergoing PAO have more pain and worse function and QOL (quality of life) scores compared to healthy participants. Patients do improve following PAO surgery, and maintain this improvement, but they do not [return] to the same level as their healthy participants."

In other words, in this analysis, patients who underwent PAO showed improvement but didn't fully return to the function levels of people without dysplasia. 

It's also worth reading outcome statistics carefully, since the same numbers can be framed in different ways depending on how researchers define their terms. 

For example, in a 2020 paper on PAO, researchers report that "the majority of the patients...have no or low pain. The operation is effective with a good clinical outcome." 

Worth looking closely at how "no or low pain" is defined in this paper.

The researchers used HOOS (Hip disability and Osteoarthritis Outcome Score), a questionnaire-based scoring system, to assess outcomes.

In the abstract, they report: "At the 2-year follow-up, HOOS pain improved by a mean of 26 points (CI 24–28) and a HOOS pain score > 50 was observed in 86%."

On the surface, having 86% of patients above a pain score of 50 sounds encouraging.

The detail worth knowing: the best possible HOOS pain score is 100, and a score around 50 typically reflects a moderate level of pain, not an absence of it.

You can see the HOOS scoring reference yourself. 

So a patient with a moderate, ongoing level of hip pain after PAO could still fall into the "no or low pain" category as defined in this paper.

Later in the same paper, the authors write: "At 2 years' follow-up, 86% of the preserved hips had no pain or a low pain score, defined by HOOS pain > 50."

Here, "no pain" and "low pain" are grouped into a single category defined by a score that, per the scoring reference above, corresponds to moderate pain — worth keeping in mind when comparing headline claims across different papers, since definitions like this vary study to study. 

The takeaway: PAO outcome data doesn't guarantee a return to full function or a pain-free result, and it's worth asking your surgeon directly how "success" is being defined when discussing your own likely outcome.

What Does Long-Term Research Show About PAO Outcomes? 

Because PAO is sometimes recommended as a preventive measure, it's sometimes performed on patients in their teens. What does the research show about outcomes decades later?

A paper published in 2017 followed patients over a 30-year period. 

"Thirty years postoperatively...more than 70% will develop progressive osteoarthritis, pain, and/or undergo THA (total hip arthroplasty/hip replacement)."

In that cohort, 56% of patients had a hip replacement within the 30-year window. 

The paper also notes that pain relief didn't hold steady for the whole follow-up period in this cohort: "After improvement of the clinical scores at 10-year followup, both the Merle d'Aubigné-Postel score and the HHS (Harris Hip Score) decreased to the preoperative values at 30 years followup."

In this study, patients showed improvement in the first decade, but by the 30-year mark, reported pain levels had returned to roughly where they started — even though the surgery did appear to successfully reduce hip range of motion. 

The researchers found that "typically excessive ROM in dysplastic hips is decreased to a normal level after PAO," and that this reduced range of motion persisted over the 30-year follow-up, without translating into lasting pain relief in this particular cohort. 

It's worth noting that surgical technique, patient selection, and rehabilitation protocols have evolved since the patients in this study were originally treated, so it's reasonable to ask a surgeon how more recent outcome data compares. 

In summary: in this 30-year follow-up study, PAO reduced range of motion durably, but more than 70% of patients still saw progressive changes in their hips over that period, with more than half undergoing hip replacement. Long-term pain outcomes in this cohort were less favorable than shorter-term studies alone might suggest. 

Where Does Exercise Fit In? 

To be clear about my role here: as a corrective exercise and orthopedic exercise specialist, I'm not qualified to tell you whether you personally should or shouldn't have surgery — that's a conversation for you and your orthopedic surgeon, who can evaluate your specific hip, your imaging, and your symptoms. What I can speak to is the muscular and movement side of hip health, which is my area of training. 

What I've seen with clients, online students, and commenters on my YouTube channel is that building strength and control around the hip can meaningfully improve day-to-day comfort for many people. Erica and Jacqueline are two examples worth watching. 

If you're exploring this path, it often starts with a shift in focus.

Alongside any conversations you're having about the orthopedic diagnosis itself, it can help to also pay close attention to how your muscles are functioning. Muscles move your bones, and how well they're doing that job affects how your hip feels day to day.

From there, training the hip, core, and leg muscles becomes the practical next step.

This is the idea behind what I call the ATM theory (Always Think Muscles) — not as a replacement for medical evaluation, but as a complementary lens: alongside understanding the structural diagnosis, also look closely at how the muscles around the joint are functioning.

Retraining these muscles is generally low-risk — the main downside is muscle soreness as you build strength in areas that were previously undertrained. There's a solid evidence base showing that targeted exercise can change muscle size, strength, and how muscles coordinate to control a joint. 

My perspective, as someone who works on the exercise side of hip health rather than the surgical side: it's worth exploring structured hip strengthening and discussing the research above with your surgeon before making a final decision about surgery, especially given how mixed the long-term outcome data is. Your surgeon is the right person to weigh that alongside your specific case. 

An Exercise Perspective on Hip Pain and Hip Dysplasia

The research above suggests hip pain isn't reliably explained by socket shape alone — otherwise we'd expect to see much more consistent patterns of hip problems in populations with higher rates of asymptomatic dysplasia.

Many people diagnosed with dysplasia also have notably mobile hips. PAO works partly by reducing that range of motion. Based on the 30-year data above, that reduction in motion doesn't reliably translate to lasting pain relief on its own.

From a movement-training standpoint, building strength through the hip's available range of motion is a reasonable complementary approach worth discussing with your care team — the goal being a hip that's both mobile and well-controlled by the surrounding muscles.

The specifics vary a lot by individual, but the general process looks similar across people:

Identify muscles that test weak, and strengthen them in a balanced way across the hip.

You might reasonably ask: "how would that address a shallow socket?"

Here's a useful comparison: the shoulder socket (glenoid fossa) is considerably shallower than even a dysplastic hip socket.

^{The red area is the shoulder socket, known as the glenoid fossa. Image from wikimedia commons.}

How does the shoulder joint stay functional despite that shallow socket? How do people manage push-ups, handstands, and overhead work without the arm bone slipping out of such a shallow socket?

Largely, it's the surrounding muscles. The muscles around the shoulder joint create dynamic stability across a wide range of positions.

That stability isn't automatic — it develops with training, which is part of why not everyone can do a handstand without practice.

But most people can build toward it with consistent training. 

Muscles play a major role in stabilizing a shallow joint.

Your hip socket, even with dysplasia, is still deeper than your shoulder socket — and as with the shoulder, the surrounding muscles play a major role in functional stability. 

So from a training standpoint, one reasonable goal is developing muscular control through the hip's full available range of motion.

This generally means training the glutes, hamstrings, adductors, hip flexors, and hip rotators. Many people find specific angles or directions where these muscles test weaker, and targeting those areas can be a useful focus.

Core strength is also part of the picture, particularly the ability to engage core muscles to stabilize the pelvis during movement.

This kind of training is a reasonable, low-risk approach worth discussing with your care team as part of your overall plan — whether that plan does or doesn't ultimately include surgery. 

Exercise Starting Points for Hip Dysplasia 

This varies quite a bit by individual, and figuring out what your specific hips need is a personalized process. If you have current hip pain, it's worth checking with your physician or physical therapist before starting a new exercise program, particularly if you're recovering from or considering surgery.

With that said, I'd generally start with the glutes and hip flexors.

Here's one video that will help you work on glute strength.

Then this video will help you work on your hip flexors. 

From there, work on the inner and outer hips. This follow-along video includes beginner-level exercises for both.  

Consider adding resistance once you feel ready for it. For people with more mobile hips, added resistance can help build the tension and control needed to feel stable. Some people notice they don't feel stable until resistance is introduced, and some need a fair amount of it.  

For some, that's as simple as a heavier kettlebell in a deadlift. For others, it means ankle weights across several exercises at different angles.

As a general guideline, stay within a pain-free, controllable range of motion and resistance, and check with your physician or physical therapist if you're unsure what's appropriate for your situation.

Follow-Along Workout for More Hip Stability

 This free workout comes from my Healthy Hips program with a slight twist. It includes several exercises to work on hip stability, plus detailed instructions for one exercise I consider particularly useful for hip strength.  

See also: How to Fix Muscle Imbalances

What About Massage and Stretching for Hip Dysplasia? 

If you already have more mobile hips, massage and stretching alone are unlikely to resolve a sense of tightness or tension — in my experience, that kind of tightness often responds better to strengthening than to stretching.

This can feel counterintuitive, which is part of why it's a common source of frustration for people with flexible, painful hips.

In my experience, added flexibility alone doesn't reliably resolve hip pain, and more stretching or relaxation work doesn't always resolve a feeling of "tightness."

If stretching and massage haven't been helping, it may be worth shifting focus toward hip strengthening, as covered above.

On the other hand, if your hips feel genuinely stiff and inflexible rather than loose, stretching and massage may be more useful for you. These strategies can still have a place — just don't rely on relaxation-based approaches alone if strength is what's actually needed for your hips to feel supported.

Building strength generally requires progressive loading, not just massage and stretching. 

See also: When Massage Makes Your Pain Worse

Final Thoughts on Dysplasia and PAO

Since PAO was developed in the 1980s, the research on how strongly dysplasia predicts hip pain and arthritis — and on how reliably PAO prevents them long-term — has grown more nuanced. Some studies support a strong link and clear surgical benefit; others, including several long-term studies referenced above, complicate that picture. This remains an active area of orthopedic research rather than a settled question.

From my perspective as an exercise professional, structured strength training is a low-risk, evidence-supported approach worth exploring as part of your overall plan for hip health — and it's something worth discussing alongside, not instead of, a full conversation with your physician or surgeon about your specific options, including surgery. 

Need More Help with Your Hips? 

I sincerely hope the exercise recommendations in this article are useful to you. If you're ready for a more structured approach, I encourage you to check out the Healthy Hips program.

I built this hip training program after working through my own experience with hip pain — including pain from muscles that were overtrained in some areas and undertrained in others. Having seen how differently hip pain can show up from person to person, I designed the program to be flexible enough to address a range of scenarios.

My goal was to build a program that helps people build stronger, more capable hips, with as little risk as possible. I can't guarantee it'll be the right fit for every case of hip pain, but if you try it and it doesn't work for you, you'll get your money back.