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Hip Dysplasia-Adolescent Treatment

Hip Dysplasia-Adolescent

TREATMENT

Treatment for adolescent hip dysplasia focuses on delaying or preventing the onset of osteoarthritis while preserving the natural hip joint for as long as possible.

Nonsurgical Treatment

Mr Slattery may recommend nonsurgical treatment if there is mild hip dysplasia and no damage to the labrum or articular cartilage. Nonsurgical treatment may also be tried initially for patients who have such extensive joint damage that the only surgical option would be a total hip replacement.

Common nonsurgical treatments for adolescent hip dysplasia include:

Observation

If your child has minimal symptoms and mild dysplasia, simply monitoring the condition to make sure it does not get worse may be an option.

Physiotherapy

Specific exercises can improve the range of motion in the hip and strengthen the muscles that support the joint. This can relieve some stress on the injured labrum or cartilage.

Lifestyle modification

Avoiding the activities that cause the pain and discomfort may give may give releif. For a child who is overweight, losing weight will also help to reduce pressure on the hip joint.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help relieve pain and reduce swelling in an arthritic joint. In addition, cortisone is an anti-inflammatory agent that can be injected directly into a joint.

Surgical Treatment

Mr Slattery may recommend surgery if your child is experiencing pain and has limited damage to his or her articular cartilage. The surgical procedure most commonly used to treat hip dysplasia is an “osteotomy”. Osteotomy literally means “cutting of the bone.” In an osteotomy, Mr Slattery reshapes and reorients the acetabulum and/or femur so that the two joint surfaces are in a more normal anatomic position.

Periacetabular osteotomy (PAO)

Currently, the osteotomy procedure used to treat adolescent hip dysplasia is a periacetabular osteotomy (PAO). “Periacetabular” means “around the acetabulum.”  This is a highly specialised procedure which is done by select surgeons worldwide after extensive training.  It was pioneered in Switzerland, where Mr Slattery has undertaken fellowship training to learn the intricacies of this procedure.

In most cases, PAO takes 2-3 hours to perform. During the surgery, cuts in the pelvic bone around the hip joint  are made to loosen the acetabulum.  It is then rotated, to re-orient the hip socket into a more normal anatomic position over the femoral head. Small screws are used to hold it in place until it heals.

More information about PAO here

(A) In a periacetabular osteotomy, four cuts are made in the pelvic bone. (B) The bone fragments are manipulated to deepen the socket.

Arthroscopy

This can be utilised in select cases to treat developmental dysplasia, however, it also has the potential to destabilise the hip joint and worsen symptoms.  It does not alter the underlying shape of the bone which is of key importance to the long term success of surgery.

Outcomes

Periacetabular osteotomy has been shown in many studies to be successful in delaying the need for an artificial hip joint, relieving pain and increasing function. Whether or not a total hip replacement will be needed in the future depends on a number of factors, including the age of the patient and the degree of osteoarthritis that was present in the joint when the PAO was performed.

periacetabular osteotomy xray
In this X-ray image, the acetabulum has been repositioned using a periacetabular osteotomy, and the bones are held in place with screws.
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