The goals of treatment for hip dysplasia are to decrease pain and prevent the early development of degenerative arthritis. Once pain becomes enough to interfere with normal activities, it may be advised to treat the dysplasia surgically.
Surgery is performed to redirect the socket and also rarely the upper femur. The socket is redirected using a periacetabular osteotomy (PAO) or Ganz Osteotomy. In severe cases, the upper femur is also addressed using a proximal femoral osteotomy. This redirection positions the joint such that body weight is spread over a larger area, therefore decreasing pain and slowing the progression of arthritis.
Periacetabular Osteotomy
The PAO is performed with the patient laying flat on the operating table. A spinal or general anesthetic is used during the procedure. An incision is made over the front of the hip, exposing the inside of the pelvis and front of the hip joint. The bone around the socket is then cut. These cuts release the socket from the pelvis, enabling repositioning.
The socket is then repositioned to cover more of the femoral head and is fixed with screws. These screws hold the bone fragments while they heal. This bone healing begins immediately, but doesn‘t have significant strength until 2 to3 months after surgery, similar to fracture healing.
Usually patients stay in the hospital for 3 to 4 days. Therapy begins immediately to strengthen the muscles around the hip joint. Weight bearing is restricted to toe touch, as too much weight bearing too early can cause breakage of the screws and change in the socket position. At six weeks, weight bearing is increased gradually to full as pain permits. Once bone healing has occurred, activity can be resumed unrestricted.
The goals of this surgery are to decrease pain and slow or stop the progression of hip degeneration. This hip socket remains shallow, but is repositioned such that it better supports weight and decreases the damaging strain on the cartilage.