Treatments for hip dysplasia include physical therapy (to strengthen muscles), activity restriction, weight loss, and/or pain medication. Though useful as a part of surgical interventions, non-operative measures to treat the symptoms of dysplasia do not treat the underlying mechanical problems of articular misalignment.
If an anatomic abnormality of the acetabulum is causing hip symptoms and if surgery can correct the abnormality, then surgery should be considered. The timing of surgery is important because the wearing out of the cartilage inside the hip joint becomes permanent at some point. Damaged cartilage heals poorly, therefore, it is important to intervene early.
A Hip Arthroscopy is a minimally invasive technique for treating secondary problems inside the hip. Arthroscopy alone cannot correct the major problem of the abnormal orientation of the acetabular rim in dysplasia though it can be used in conjunction with Periacetabular osteotomy (PAO)
Arthrotomy is a procedure in which the capsule surrounding the hip joint is opened. Some minor problems of the labral cartilage and femoral head can be treated with this procedure. This is often performed at the same time as the PAO.
Osteoplasty, done in addition to the PAO, involves re-alignment of the head and upper end of the femur.
Periacetabular osteotomy (PAO) is the primary surgical correction of Hip Dysplasia. Only realignment operations like PAO can correct the underlying mechanical problem and abnormal tilt of the acetabulum. For more information see the article on PAO
Total Hip Replacement (THR) refers to replacement of an arthritic joint with an artificial joint. If done in active young patients, the artificial joint may very likely wear out and require additional surgery.
Surface replacement is a form of hip replacement where the femoral head and neck are preserved but the cartilage of the femoral head and acetabulum are replaced with a metal bearing surface.
Fifty years ago, particularly in Europe, hip osteotomy was often used as a treatment for certain adult hip problems. With the first successful total hip replacement (THR) by Charnley in England in the 1960s, osteotomy was abandoned by many surgeons. THR gave excellent early results in eliminating pain and restoring motion in patients with osteoarthritis of the hip. The most common failure THR is the loosening of the artificial hip at its bond to the patient’s own bone. If this occurs, the person may require another THR. Surgery to replace a failed THR with another THR is called revision replacement, and it is technically much more challenging for the surgeon than the first replacement. In addition, the revision replacement typically involves much more extensive healing period than the first hip replacement.
In the past twenty years, there has been a growing interest in adult hip osteotomy as a means for preserving hip joints with certain mechanical problems rather than treating them with replacement. Long-term follow-up results of THR have shown an increasing incidence of certain worrisome problems, especially in young active patients. Hip replacements in general are much less stable than the patient’s own hip. They are more subject to infection. Because artificial hip replacements involve the insertion of a large foreign body inside the patient, many patients experience usually benign but occasionally troublesome responses to metal ions in organs far from the hip. Osteotomy and other hip joint preserving procedures are not an inferior second choice to THR, though the recovery for the PAO patient is typically longer than after a primary THR. With PAO, living tissue with its healing capabilities and physical sensation allows hip function that is more normal than with a typical hip replacement. The usual hip replacement patient is warned regarding range of motion and activities that lead to premature failure of the artificial joint. PAO patients have no range of motion restrictions or precautions, although we do recommended that after PAO people approach high-impact activities with caution.
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© 2012-2014 Jit Balakumar - Paediatric & Adult Orthopaedic Surgeon, Melbourne
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