For most adolescents the treatment of hip dysplasia focuses on using surgery to preserve the hip and reduce pain. The dysplastic hip will eventually wear out and become painful and arthritic, but it may be difficult to predict when that day will come. While waiting is often an option for older adults, it is generally better to proceed with surgery for hip dysplasia that is causing pain in adolescents. Sports, dance and other activities can usually resume after the hip dysplasia has been treated.
Non-operative treatment may be chosen in very mild dysplasia with mild symptoms. Non-operative therapies designed to decrease pain for adolescents include; weight loss, lifestyle modification, and specialized physical therapy. For example, choosing cycling or swimming instead of high impact sports, like running and basketball, may put less stress on the hips.
Hip arthroscopy is a minimally invasive technique that has increased in popularity because of new technology with improved ways to stretch the hip and insert scopes that work inside the joint. Hip dysplasia must be carefully evaluated prior to hip arthroscopy because a shallow socket may need to be improved in order to prevent additional problems when hip arthroscopy is performed without correcting the underlying bone support.
Hip Preserving Surgery
In adolescents there are a variety of hip preserving surgical procedures that may be helpful. The upper part of the femur may also need surgery, especially when dysplasia is still present following childhood treatments. Special methods for pelvic surgery may be needed before full maturity. For most adolescents with advanced hip dysplasia the periacetabular osteotomy (PAO) is a preferred surgery to change the orientation of the hip socket so it is in a better position to cover the ball of the hip joint (femoral head). A series of cuts is performed around the acetabulum to allow the socket to be reoriented in an effort to restore normal alignment. Screws are then placed to hold the socket in its new position until the bone heals. In a small percentage of patients the surgeon may also need to perform bone cuts (osteotomy) on the upper femur to further improve the alignment of the hip.
PAO is a very successful surgery for improving the longevity of the hip joint and pain in patients who have been diagnosed before extensive injury to the hip cartilage. The youngest candidates for PAO are approximately eleven years of age. Adolescents usually have the fastest recovery time, but patients up to their 40’s have benefitted from PAO surgery as long as their hips are not too arthritic. Patients with advanced cartilage injury and arthritis may not be good candidates for a PAO.
Femoral osteotomy (the ball side of the joint) has also been reported with some success and is performed on a small percentage of patients. In this procedure, the upper femur is re-aligned to change the mechanics and allow weight-bearing on a fresh part of the femoral head. Femoral osteotomy is rarely used as the only procedure in the USA although promising results have been reported in Europe and other parts of the world. Usually, femoral osteotomy is combined with pelvic osteotomy when there is deformity of the upper femur from abnormal growth and development. These techniques are variable and depend on the shape of the upper femur. If more information is needed, it’s best to consult your doctor or see the textbook by Richard Bowen, MD in the Professional Resources for Orthopedic Surgeons.
Other Pelvic Osteotomies
There are also other types of osteotomies on the hip socket side of the joint. In Japan, a modification of the PAO may be preferred. That modification cuts a circle around the hip socket and rotates the socket itself. This is called a “rotational” or “spherical” osteotomy. Other pelvic osteotomies that have had some success are the “triple innominate osteotomy,” “Chiari osteotomy,” and procedures that create a deeper socket or re-align the existing socket. The Triple Innominate Osteotomy uses similar principles to the PAO and can be performed prior to skeletal maturity.
Joint Replacement Surgery
Saving your own hip is the first choice for adolescents. When this is not an option for younger patients, new techniques of joint replacement surgery have shown that long term results can be very satisfactory even before the age of twenty. Many professional athletes have returned to high levels of competition in non-contact sports following total hip replacement or hip resurfacing procedures. These are sometimes called joint “arthroplasty” and uses artificial parts to replace the damaged joint. The two main categories of hip replacement procedures are hip resurfacing, and traditional total hip replacements.