Understanding Your Treatment

Treatment of hip dysplasia depends on the age of the patient, severity of dysplasia, presence or absence of arthritis, degree of symptoms, and patient expectations. In patients with mild dysplasia and symptoms, physical therapy for core strengthening or a short course of anti-inflammatory medications may be indicated. If patients are more symptomatic or have mild symptoms but a more severe degree of dysplasia, a surgery called a periacetabular osteotomy may be indicated. Also referred to as a Ganz osteotomy or a PAO, this surgery involves cutting the pelvic bone and then rotating the socket to a more normal position. The cut socket is then reattached to the pelvis using screws.

Patients with hip dysplasia that have painful hip arthritis are often best served with hip replacement surgery. The periacetabular osteotomy surgery is usually performed on patients under age 40, but occasionally, individuals over age 40 are candidates for this surgery. In most cases, individuals over age 40 with painful hip dysplasia already have moderate arthritis, and are therefore usually best treated with hip replacement surgery.

Hospital Course

The surgery is performed using general anesthesia. During surgery, the bone around the hip socket is cut, and the socket is repositioned to correct the dysplasia. The repositioned bone is secured using screws, so a cast is not necessary following surgery. The patient typically is hospitalized overnight following surgery and discharged home on crutches and a blood thinner. Weight bearing on the surgical leg is restricted for a minimum of 6 weeks. A pool walking program is initiated at 4 weeks. At 6 weeks, x-rays are obtained, and if there is sufficient healing at the osteotomy site, a weight bearing progression program is initiated. Patients may wean off the crutches when they can walk without a limp and without pain, which is typically 9-12 weeks after surgery. Patients are typically functioning with little pain by 3-5 months, but they will continue to improve for one to two years after surgery.

Outcomes

Without surgery, patients with hip dysplasia are at a higher risk of developing premature arthritis in the affected hip. The goal of surgery in patients with a painful, dysplastic hip is two-fold: alleviate the pain and reduce the risk of arthritis developing in the hip. With surgery, most patients experience very good pain relief and an improvement in overall function. Surgery in these patients also appears to delay the onset of arthritis. Younger patients and those without pre-existing arthritis are the best candidates for the surgery. Patients over age 40 and those with established arthritis in the hip have the least favorable outcomes.