What is hip dysplasia?
Hip dysplasia is a term used to refer to a hip socket that is too shallow to fit the ball portion of your thighbone known as the femoral head.
In a normal, healthy hip, the hip socket is a cup-like portion of the pelvis, known as acetabulum that receives the femoral head of the thighbone, and together these two bony components make up the hip joint. Protective cartilage covers both the femoral head and acetabulum to minimize friction between the two bones while the ball portion rotates within your hip socket. This ensures adequate support and enables load transfer across the hip joint during activities of daily living.
However, in hip dysplasia, the inadequate support from a shallow hip socket can cause your hip joint to dislocate easily from its normal position. Moreover, the misalignment causes the protective cartilage to bear the entire weight that should otherwise be distributed throughout your hip. If left untreated, the overloaded cartilage wears out, leading to early onset of osteoarthritis (joint inflammation that occurs when the cartilage degenerates or wears down).
What is the cause of Hip Dysplasia?
Hip dysplasia most often develops at birth or in early childhood, referred to as developmental dysplasia of the hip (DDH). However, the majority of these children progress into their teens or early adulthood without any noticeable signs and symptoms.
DDH appears to run in families. It most often occurs in:
- Girls
- First babies
- Babies born in the breech position
How to know if you have Hip Dysplasia?
Years of stress due to the improperly aligned hip socket triggers pain and stiffness in the joint as the cartilage wears out and the two bones start rubbing against each other. The pain usually affects the groin area. Often there is a feeling of catching, popping, or locking inside the groin with movement. Limping may also be present.
When suspected of having hip dysplasia, Dr. Downer carries out the necessary examination. Imaging studies like x-rays, CT scan, and MRI help pinpoint the position of the hip socket in relation to the femoral head and the degree of dysplasia, arthritis, as well as damage to the cartilage.
What are your treatment options?
At OSS, the goals of treating hip dysplasia are to minimize pain and prevent the premature degeneration of the hip cartilage and subsequent arthritis.
Nonsurgical treatments
If your symptoms are mild and there’s no damage to the cartilage or hip socket, Dr. Downer undergoes a trial of nonsurgical treatments at first.
Common nonsurgical treatments for hip dysplasia include:
- Lifestyle modification
- Physical therapy. Gentle exercises can improve the range of motion in your hip and strengthen the muscles supporting the joint.
- Pain and inflammation-relieving pills to alleviate pain and swelling in an arthritic joint. Moreover, cortisone, an anti-inflammatory agent may also be injected directly into the affected joint for temporary relief.
Surgical treatments
If the above treatments are not successful and pain becomes severe enough to interfere with daily activities, Dr. Downer recommends surgical correction of dysplasia. If the symptoms are too advanced from the beginning, surgery is advisable at the outset.
Periacetabular osteotomy (PAO), also known as Ganz Osteotomy, is the surgical procedure performed to correct hip dysplasia.
- “Peri” means surrounding,
- “Acetabulum” is the hip socket, and
- “Osteotomy” means to cut the bone
Hence, PAO means to cut the bone around the hip socket and reposition the socket for better alignment. In severe cases, the upper portion of your thighbone is also readdressed – a procedure called proximal femoral osteotomy.
What is the procedure for PAO?
The PAO is carried out with the patient lying flat on the operating table. Medications to put you in a sleep-like state are given. After the necessary preparations, the surgeon makes a cut over the front of the hip, exposing the inside of the pelvis and front of the hip joint.
The pelvic bone around the hip socket is then cut in different steps, so as to free the socket from the rest of the pelvis. The separated socket of the hip is then repositioned to cover the femoral head adequately and support your weight. The redirected socket is finally held in place with screws to enable bone healing similar to fracture healing. These screws hold the repositioned fragments as they heal.
What to expect after the procedure?
The bone starts healing immediately but will lack enough strength until 2 to 3 months after surgery.
The hospital stay after PAO is about 3 to 4 days depending on your ability to get out of bed. The treated leg will feel heavy for a few days. Some swelling, bruising, and numbness in the hip are common complaints and may take a while to go away. Therapy to strengthen the muscles around the hip joint begins right away. In most cases, you’ll be able to use crutches after 2 to 3 days. However, weight-bearing should be limited to toe touch to prevent breaking the screws and altering the socket position.
At six weeks, weight bearing is increased gradually to its full potential as pain permits. When complete bone healing takes place, you may resume unrestricted activity.
Will surgery fix your problem?
When performed by an expert surgeon like Dr. Downer, PAO yields effective results with minimal to no complications. While the hip socket will still remain shallow, the realignment of the hip socket positions the joint such that your body weight is spread over a larger area, limiting the strain on the cartilage during activities of daily living. The improved biomechanics thus curbs the pain and delays or prevents arthritis. Moreover, a PAO will help preserve your natural hip joint, deferring or even completely eliminating the need for a total hip replacement surgery.
How long will you need to be off work after PAO?
Desk work can begin days after surgery. Manual labor is not feasible for about two and a half months.
When can you resume recreational activities?
Biking and swimming are good usually after about 2 weeks. Impact sports are not recommended until after 3 months.
When can you drive a car?
Once you are off the narcotic pain killers, you can drive a car.
To schedule a consultation with Dr. Downer, please feel free to call Orthopedic Specialists of Seattle at 206-784-8833.
