Surgery is recommended as the definitive treatment for patients with hip dysplasia that have not improved with non-surgical treatment (anti-inflammatories, physical therapy, and injections). It is the only treatment that effectively corrects the mechanical problem of hip dysplasia and the resultant labrum and cartilage injuries. The goals of surgery are three-fold: [1] to decrease or eliminate groin and hip pain associated with hip dysplasia and a torn labrum; [2] to improve function by positioning the socket in the best position for weight bearing and higher-impact activities without pain; and [3] to delay the onset and progression of hip arthritis. Research shows that all three of these goals can be achieved with a high success rate and good reproducibility. Our goal for each patient is for him or her return to the highest possible functional level, whether that is painless daily activities or elite level sports, for the longest time possible.
Hip dysplasia is frequently approached with two surgeries – hip arthroscopy and a periacetabular osteotomy (PAO). The objective of a hip arthroscopy is to evaluate the cartilage, labrum, and other hip structures, and fix small tears or clean up loose bodies in the joint. A hip arthroscopy is performed by making 3-4 small (1/2”) incisions around the hip joint, then inserting a small camera. During the arthroscopy, any labrum tears are fixed using special tools and affixing anchors to the bone in order to tie the torn labrum back down to the rim of the socket. Other tools are used to trim any frayed labrum or cartilage, re-contour the ball (femoral head) to make it more perfectly spherical, and to close or tighten the joint capsule with sutures. Total surgical time for the hip arthroscopy is typically 1 – 2 hours.
In the event that extensive arthritis is already present in the joint, the surgery would conclude with the hip arthroscopy, as the PAO would not benefit a patient with advanced joint degeneration. The vast majority of patients have cartilage healthy enough to proceed with the PAO, especially at a younger (<30) age. The PAO portion will then proceed after the hip arthrosocpy. This can be done the same day, but is often staged (or spaced out) approximately two weeks apart to allow swelling to decrease and minimize time under anesthesia.
The PAO begins with a bikini-line incision on the side of the pelvic bone and extends to the front of the hip. Then the pelvic bones around the cup are cut using special tools and x-ray to guide the orientation and position of the cuts. The pelvis is cut in a way to keep part of it intact, which allows for partial weight-bearing after surgery. When the cuts are complete, the socket fragment becomes free and mobile. The socket fragment is repositioned to an optimal position, checked on x-ray, and then fixed in place using 3-5 metal screws. All of the soft tissues and muscles are then carefully re-placed and sutured, then the skin is sutured closed. Total surgical time for the PAO is typically 2-4 hours. Patients who are undergoing the full surgery, inclusive of both the hip arthroscopy and the PAO, should allot 7-8 hours, including anesthesia, hip arthroscopy, re-positioning, the PAO, and post-op recovery.
Post-operatively patients stay in the hospital for 2-4 days for monitoring, pain control, and physical therapy. Patients cannot put full weight on the operative leg, and will need to use crutches or a walker to limit the amount of weigh to 30 pounds. A brace will be provided to limit certain ranges of motion and positions to protect the surgical repair and osteotomy, and the brace and limited weight bearing will continue for 6 weeks. After full weight bearing is achieved, therapy continues to be important to regain strength. A strenuous strengthening program and running can begin at 3 months with full return to sport beginning as soon as 6 months after surgery..