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Hip Dysplasia Surgery Overview

The hip is a "ball-and-socket" joint. In a normal hip, the ball at the upper end of the femur (thighbone) fits firmly into the socket, which is a curved portion of the pelvis called the acetabulum. In a young person with hip dysplasia, the hip joint has not developed normally, the socket is too shallow to adequately support and cover the ball (head of the femur). This abnormality can cause a painful hip and the early development of osteoarthritis, a painful and debilitating condition where the joint wears away and bone rubs against bone.

The hip is one of the body's largest joints. It is a "ball-and-socket" joint. The socket is formed by the acetabulum, which is a part of the large pelvic bone. The bone surfaces of the ball and socket are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones and enables them to move easily.

The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket, creating a tight seal and helping to hold the femoral head in place.

Surgery For Hip Dysplasia Description

In patients with hip dysplasia, the acetabulum is shallow, meaning that the ball, or femoral head, cannot firmly fit into the socket. As a result of this abnormality, there is increased stress on a smaller area of the joint, which can result in pain and early degeneration of the hip. The labrum can end up bearing the forces that should normally be distributed evenly throughout the hip joint. In addition, more force is placed on a smaller surface of the hip cartilage and labrum. Over time, the smooth articular cartilage becomes frayed and wears away and the labrum becomes torn or damaged. These degenerative changes can progress to osteoarthritis.

The magnitude and severity of hip dysplasia can vary from patient to patient. In mild cases, the head of the femur may simply be loose in the socket. In more severe cases, there may be complete instability in the joint and/or the femoral head may be completely dislocated out of the socket.

What Causes The Need to Do Hip Dysplasia Surgery?

Adolescent hip dysplasia usually results from developmental dysplasia of the hip (DDH) that is undiscovered or untreated during infancy or early childhood.

DDH tends to run in families. It can be present in either hip or in any individual. It usually affects the left hip and occurs more often in:

Girls
First-born children
Babies born in the breech position

Symptoms According To a Hip Dysplasia Specialist

Hip dysplasia, itself, is not a painful condition. However, pain results when the altered forces in the hip cause degenerative changes to occur in the articular cartilage and the labrum. In most cases, this pain is:

Located in the groin area, although it may sometimes be more toward the outside of the hip
Occasional and mild initially, but may increase in frequency and intensity over time
Worse with activity or near the end of the day
Some patients may also experience the feeling of locking, catching, or popping within the groin.

Hip dysplasia can also result in symptoms like limping or unequal leg lengths.

What to Do If You Suspect The Need of Hip Dysplasia Surgery

In most cases, adolescent hip dysplasia can be diagnosed with x-rays.

If you or your child is exhibiting some or all of these symptoms, you're right to suspect that it could be hip dysplasia. Consult a medical professional to ensure early diagnosis and treatment, which will prevent the condition from deteriorating and make recovery easier to achieve. You will likely be referred to a hip dysplasia doctor, or an orthopaedic surgeon, in order to receive an accurate diagnosis and correct treatment from a hip dysplasia specialist.

How Our Hip Dysplasia Doctor Conduct Imaging Process

In most cases, adolescent hip dysplasia can be diagnosed with x-rays.

X-rays

These provide images of dense structures such as bone, and will help your hip dysplasia doctor assess the alignment of the acetabulum and femoral head. An x-ray can also show signs of arthritis.

Computed tomography (CT) scans

More detailed than a plain x-ray, CT scans can help your doctor establish the degree of dysplasia.

Magnetic resonance imaging (MRI) scans

These studies can create better images of the body's soft tissues. An MRI can help your hip dysplasia doctor find damage to the labrum and articular cartilage.

**(Left)** This x-ray shows two normal hips. **(Right)** The red arrow shows a dysplastic hip. The hip socket is shallow and there is only partial coverage of the femoral head.

Treatment By Our Hip Dysplasia Doctor

Treatment for young adult hip dysplasia focuses on delaying or preventing the onset of osteoarthritis while preserving the natural hip joint for as long as possible, and alleviating pain and symptoms. Hip dysplasia surgery is the best option for some cases, but there are also many non-surgical treatments for less severe cases.

Nonsurgical Treatment

Your orthopaedic surgeon may recommend nonsurgical treatment if there is mild hip dysplasia and no damage to the labrum or articular cartilage. Nonsurgical treatment may also be tried initially for patients who have such extensive joint damage that the only surgical option would be a total hip replacement in Melbourne.

Common nonsurgical treatments for adolescent hip dysplasia include:

Observation

If your child has minimal symptoms and mild dysplasia, simply monitoring the condition to make sure it does not get worse may be an option. Infants under six months old might also be placed in a brace during this period.

Lifestyle modification

Avoiding the activities that cause the pain and discomfort may give may give relief. This includes running, climbing stairs and impact sports. However, moderate exercise of certain kinds, like swimming, can be helpful. For a child who is overweight, losing weight will also help to reduce pressure on the hip joint.

Physiotherapy

Specific exercises can improve the range of motion in the hip and strengthen the muscles that support the joint. This can relieve some stress on the injured labrum or cartilage. Consult with your specialist if you wish to be referred to a physiotherapist.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help relieve pain and reduce swelling in an arthritic joint. In addition, cortisone is an anti-inflammatory agent that can be injected directly into a joint.

Surgical Treatment

Your surgeon may recommend hip dysplasia surgery if you are experiencing pain which is not responding to non-operative treatment. The surgical procedure most commonly used in the early stages to treat hip dysplasia is an "osteotomy". Osteotomy literally means "cutting of the bone." In an osteotomy, your hip dysplasia surgeon reshapes and reorients the acetabulum and/or femur so that the two joint surfaces are in a more normal anatomic position. Surgery for hip dysplasia has a high success rate and can relieve your symptoms and treat the issue.

Periacetabular osteotomy (PAO)

Currently, the osteotomy procedure used to treat adolescent hip dysplasia is a periacetabular osteotomy (PAO). "Periacetabular" means "around the acetabulum." This is a highly specialised procedure which is done by selected hip dysplasia surgeons worldwide after extensive training.

In most cases, PAO takes 2-3 hours to perform. During the surgery for hip dysplasia, cuts in the pelvic bone around the hip jointare made to loosen the acetabulum. It is then rotated, to re-orient the hip socket into a more normal anatomic position over the femoral head. Small screws are used to hold it in place until it heals.

In this X-ray image, the acetabulum has been repositioned using a periacetabular osteotomy, and the bones are held in place with screws.

Arthroscopy

Hip dysplasia in the long term can lead to hip arthritis due to overload of the bone, and wear of the cartilage, this can result in the need for a total hip replacement.

Outcomes and and long-term risks

Hip dysplasia in the long term can lead to hip arthritis due to overload of the bone, and wear of the cartilage, this can result in the need for a total hip replacement.

Periacetabular osteotomy has been shown in many studies to be successful in delaying the need for an artificial hip joint, relieving pain and increasing function. Whether or not a total hip replacement will be needed in the future depends on a number of factors, including the degree of osteoarthritis that was present in the joint when the PAO was performed.

Frequently Asked Questions Around Surgery For Hip Dysplasia

I have been diagnosed with hip dysplasia as a teenager, however have I always had hip dysplasia?

In many cases adolescent hip dysplasia is a progression of paediatric hip dysplasia, and patients will have had some failure of hip formation as a younger child. In some cases patient may have had treatment as a child for hip dysplasia and may have had a relatively normal hip, however over time the hip joint formation regresses, and this can result in poor socket formation as an adolescent.

How long is recovery after hip dysplasia surgery?

This depends on the nature of the surgery which is undertaken. After a periacetabular osteotomy, most patients are back to playing sport and activities at approximately 3-4 months.

I get clicking and catching in my groin, is this a sign of hip dysplasia?

Clicking and catching in the groin can be a sign of hip dysplasia, and instability of the hips lies in and out of its socket. If you have these symptoms, we would highly recommend that you are evaluated by a hip specialist in Melbourne.

I have hip dysplasia, what is the risk of developing hip arthritis?

This is a very difficult question to answer without a thorough evaluation of your x-rays and an assessment of your condition. The risk of developing arthritis is directly related to the amount of bony coverage of the ball of the femur.

Hip Dysplasia Surgery