Adult Hip Dysplasia Update 2016

Hip xray shutterstock

A review of current concepts for Adult Hip Dysplasia was published in the January, 2016 issue of the Journal of Bone and Joint Surgery. Here is a summary of that report:

  • Irregular shape of the ball or socket increases the wear and tear on the hip joint. This is responsible for most of the cases of osteoarthritis of the hip
  • Hip Dysplasia on the socket side is a factor in 20% to 40% of patients with osteoarthritis of the hip. Few of these are diagnosed or treated in childhood by current screening methods
  • The first sign of trouble is usually groin pain in front of the hip joint between the abdomen and the thigh
  • Special x-ray views may be needed for correct diagnosis of the problem
  • The soft rim around the socket – called the labrum – “…can be remarkably effective at maintaining the mechanical equilibrium and preventing symptoms until adulthood”
  • In adulthood labral tears may develop in response to inadequate support from the shallow socket
  • Arthroscopic repair or removal of labral tears generally have early success but results begin to deteriorate by two years after surgery
  • Results may be improved when arthroscopic repair is combined with surgery to realign the bone structures
  • The Ganz Periacetabular Osteotomy (PAO) is the most commonly used procedure to realign the bones for improved support in young adults with hip dysplasia
  • PAO Surgery is complicated and is best performed by experienced surgeons
  • Successful results of PAO Surgery are best in the following people
    • Age younger than 35 years
    • Early stages of arthritis
    • Ball – femoral head – is centered in the shallow socket
  • Overall success rate for PAO surgery is approximately 75% ten years after surgery and 60% twenty years after surgery. Results are almost 90% successful ten years after surgery for people in the best success category
  • Older people, or those with slightly displaced hips, or more advanced arthritis may benefit from PAO when combined with other surgical procedures such as femoral osteotomy
  • Total hip replacement is an excellent option for patients who are older or who have more advanced arthritis
  • Total hip replacement has approximately the same success rate whether previous hip osteotomy surgery has been performed or not.

 

IHDI Commentary: The first PAO Surgery was performed in 1982. This procedure has provided pain relief and restored activity levels for thousands of people who previously were told to live with their problem until they were old enough to have a total hip replacement. During the same period of time, total hip replacement has improved for younger individuals. The role of both of these procedures for young adults with hip dysplasia continues to evolve. The good news is that PAO surgery and total hip replacement have improved the outlook for people suffering from hip dysplasia at a young age. Nonetheless, hip dysplasia is a common problem that causes a lot of disability and the IHDI will continue its efforts to prevent this problem for children and adults.

 

Click here to view the complete article: http://jbjs.org/content/98/1/63

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