What is hip dysplasia?
Hip dysplasia or developmental dysplasia of the hip (DDH) is a condition that can develop in early childhood as an infant and require bracing or surgery. Other times it is subtle and will manifest as hip pain in adolescence or early adulthood. It’s main component is a shallow or deficient acetabulum (socket) that does not adequately cover the femoral head (ball). When this occurs the hip can be frankly dislocated (ball out of the socket), which can occur in the infantile form. Or more commonly present with hip instability. The signs and symptoms of instability from DDH can be dismissed as a groin pull or muscle strain as usually x-rays have only subtle signs that can easily be missed.
How is dysplasia treated?
This is mainly determined by age, symptoms and if the socket is slightly or very deficient. When present in infants it is generally treated with bracing, in toddlers is sometimes can require a surgery to put the hip back in place and can be combined with a small pelvic osteotomy. When the pelvis is fully developed a periacetabular osteotomy can be performed, with the goals of all treatments to preserve the native anatomy and provide a stable functional hip. If the dysplasia has resulted in arthritis then generally the only treatment option left is a total hip replacement.
What is a periacetabular osteotomy (PAO)?
A PAO or also called a Bernese or Ganz osteotomy was developed by Dr. Reinhold Ganz in Bern, Switzerland. It is a procedure designed to cut out the socket and turn it or reposition it in a preferred orientation to increase the coverage of the ball. It is performed through various shaped incisions but involves 4-5 cuts through the pelvic bones. Once it has been reoriented the fragment is held in place with multiple large screws.
Who should have a PAO?
There are many factors that determine whether or not a patient should or shouldn’t have a PAO. If there is no cartilage damage (no arthritis), generally young (younger than 35-40; though good outcomes are common in older individuals), of a healthy weight (increased complications with BMI >35), and x-rays/MRI/CT show that the ball is not adequately covered by the socket then a PAO may be indicated.
Who should not have a PAO?
If your joint already has end stage arthritis then a PAO is most likely not indicated. In this a total hip arthroplasty (THA) is indicated. However if this damage is minimal, the dysplasia is severe and/or you are an adolescent, then some times a PAO would be performed knowing that it may not preserve the joint for as long as typically expected with a PAO.
Why not just have a hip replacement?
A total hip replacement is a very successful surgery. It can predictably provide pain relief and increase function in those that suffer from debilitating arthritis. However, it is not indicated in those patients with well preserved cartilage. It also carries significant risks as well. And young individuals will likely outlive their bearing surfaces used in the hip replacement and often require a revision procedure to exchange the bearing surfaces, but leaving the large metals parts in place. With that said new bearing surfaces are projected to provide 20-25 years of longevity prior to needing revision.
How long does a PAO last?
This is based on many factors as mentioned above. But in the ideal candidate without arthritis and proper correction, it is expected to have a well-preserved hip in 2/3 of patients at 20 years and 1/3 of patients at 30 years. And this is based on the original group of PAO patients under Dr. Ganz. Future long-term outcomes could be improved with narrower patient selection and newer techniques that address labral pathology as well.
What can I expect from recovery?
Recovery time is variable. In general, it can be expected that younger patients recover quicker and also will have the osteotomy heal sooner. The average hospital stay is 3-6 days. The first 2-3 days after the epidural is removed are the most painful but pain is usually controlled thereafter. The front part of the hip will off and on be aggravated as this is where the muscles and scar tissue are healing. The dressings will stay on for 2 weeks. Crutches or a walker are used until you are able to place full weight on your leg. Most patients will be limited in the amount of weight they can place on their operative leg for 6-8 weeks and then will be allowed to start weight bearing as tolerated with 2 crutches or a walker at that time as long as the x-rays demonstrate bone healing. It is expected to limp for a while after surgery and a cane or crutch should be used while limping to decrease pain and eliminate gait disturbance. Outpatient physical therapy will begin when you are able to transport safely and relatively pain free. Home health therapy will start once you discharge to home.
As this surgery is a controlled pelvic fracture the recovery time can be prolonged but most patients should expect to feel well at 3 months. Return to sporting activities may not occur until up to a year from your surgery date. Even after full recovery daily stretching and short exercise may be required to “loosen up” the hip and decrease some residual symptoms.
I’m an athlete, will I ever play sports again?
The two primary goals of a PAO are to decrease painful symptoms and preserve the native hip for decades. Unfortunately, as a consequence some patients will not be able to return to high level competitive sports for various reasons; with that said, many will. 60-80% of patients can be expected to return to sport, though this is tougher for high level athletes versus recreational athletes.
More information can be found here at the Hip Dysplasia Institute
Have questions about hip dysplasia or hip pain in general, Call to schedule an appointment today. Dr. Woyski is well versed in conservative and operative hip treatments. Whether it's hip arthroscopy, hip replacement or a periacetabular osteotomy he can help! We also offer same day in office ultrasound guided hip joint injections!