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’s 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 40 are candidates for this surgery. In most cases, individuals over 40 with painful hip dysplasia already have moderate arthritis, and are therefore usually best treated with hip replacement surgery.

Hospital Course

Most patients receive both an epidural and a general anesthetic. The epidural helps reduce postoperative pain and will be left in place for two days after surgery. During surgery, the bone around the hip socket is cut until the socket can be repositioned to correct the dysplasia. The repositioned bone is secured using screws, so a cast or brace is not necessary following surgery. The patient typically is in the hospital for 3 days 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 gentle home exercise program is initiated at 4 weeks. At 6 weeks, x-rays are taken and full weight bearing is allowed 6-8 weeks after surgery. Patients typically wean off their crutches by 12 weeks and formal therapy is initiated at that time. Patients are typically functioning with little pain by 3-5 months, but they will continue to improve for one year after surgery.

Outcomes

Without surgery, patients with moderate hip dysplasia are at increased risk of developing premature arthritis in their 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.