In general, treatment for hip dysplasia focuses on using surgery to preserve the hip and reduce pain. An early diagnosis of hip dysplasia provides more options for treatment. The dysplastic hip will eventually wear out and become painful and arthritic, but it may be difficult to predict when that day will come.
Patients with hip dysplasia who experience pain, but do not have severe cartilage damage, may be candidates for surgery to improve the pain and help preserve the hip. There are generally two broad types of surgery performed for hip dysplasia in Adults:
- PAO surgery to preserve the natural hip joint
- Total hip replacement
The Diagnosis of Hip Dysplasia includes measurements and classifications that help guide treatment decisions. https://hipdysplasia.org/adults/diagnosis/ However, each person is different and an experienced hip dysplasia surgeon is the best person to advise each individual.
Factors associated with successful periacetabular osteotomy (PAO) include age less than 35–40 years, low body mass index, maintained hip range of motion, a congruent hip joint, Tönnis grade of osteoarthritis 0–1, and lateral center edge angle of less than 20°–25° (LCEA b20°–25°).
- C.L. Peters / The Journal of Arthroplasty 2015; 30:1109–1112.
Factors which favor THA [Total Hip Arthroplasty] in the patient with acetabular dysplasia include age greater than 35–40 years, poor range of motion, more severe osteoarthritis (Tönnis grade of osteoarthritis 2 or 3), noncongruent joint on radiographs, subchondral cyst formation, and/or acetabular chondral damage on advanced imaging such as MRI with or without arthrogram or dGEMERIC techniques. Additionally, a 20-year follow-up study of the first 75 PAOs performed in Berne [by Prof. Ganz] revealed 60% survivorship with a positive anterior impingement test (presumably indicating labral pathology) and preoperative grade of osteoarthritis being strong factors associated with failure.
- C.L. Peters / The Journal of Arthroplasty 2015; 30:1109–1112.
Non-operative Treatment
Non-operative treatment may be chosen in very mild dysplasia with mild symptoms, or when the hip is too arthritic for surgeries to preserve the hip. Non-operative therapies designed to decrease pain include; weight loss, lifestyle modification, joint injections, 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.
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Hip Arthroscopy
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.
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Hip Preserving Surgery
A periacetabular osteotomy (PAO) is a 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. Although younger patients, such as adolescents, may have the fastest recovery time, patients up to their 40’s may have significant benefit from a PAO as long as their hips are not too arthritic. Patients with progressive cartilage injury and arthritis may not be good candidates for a PAO.
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Joint Replacement Surgery
This is also called “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.
