When is hip osteotomy recommended?
Patients with mild forms of hip dysplasia can go through non-surgical treatments with physical therapy and anti-inflammatory medication, but this is mainly for symptom control and does not change the natural course of the disease.
Hip osteotomy may be recommended if non-surgical treatments are unsuccessful, the patient’s quality of life is affected, and the dysplasia is severe. This is usually considered for patients who have reached skeletal maturity without advanced osteoarthritis. Hip osteotomy can slow down the progression of cartilage and labrum damage, and the development of arthritis in hip dysplasia, potentially delaying or avoiding the need for hip replacement.
Surgical procedure
Your orthopaedic surgeon will make an incision to provide access to the pelvis and use special instruments to make cuts in the bone to reposition the acetabulum to adequately cover the femoral head. This allows any torn labrum or cartilage to heal, and further joint damage is prevented. Screws will then be placed in the bones to stabilise the new position.
New bone forms across the cut bony surfaces during the healing process, securing the repositioned acetabulum so that the hip joint ball and socket are in proper alignment.
A femoral osteotomy may also be necessary to correct misalignment of the femur, or a hip arthroscopy may be performed along with hip osteotomy to repair damaged labrum or cartilage.
X-ray guidance is used throughout the surgery to ensure the bone cuts are accurately made and good coverage and alignment of the hip joint is achieved.
HIP OSTEOTOMY
Commonly Asked Questions
Planning for the surgery
Your orthopaedic surgeon will order X-rays, MRI, and CT scans to confirm the diagnosis, assess the severity of hip dysplasia and plan the correction required during your surgery. You may also need to consult an anaesthetist to check your general medical condition and do blood tests, a chest X-ray, and an electrocardiogram to assess your fitness for surgery.
Patients who go through hip osteotomy are usually hospitalised for two to four days.
Consult your orthopaedic surgeon for specific instructions but you have to stop taking traditional medicine, blood thinning medications and control your general medical conditions before the surgery. You should also try to lose some weight to minimise the stress on your operated hip and do some home planning such as care arrangements, installing handrails in the shower for support to facilitate your return from hospital.
Hip osteotomy is commonly performed under general anaesthesia, which may be supplemented with injections of local anaesthetic to reduce pain. Your orthopaedic surgeon and anaesthetist will discuss the best method with you.
A hip osteotomy will typically take between three to four hours.
Complications
Hip osteotomy requires open surgery, and carries a small risk of bleeding, infection, damage to surrounding nerve and blood vessels and blood clots forming in the veins. The surgery might stretch nerves and cause temporary numbness, but this usually recovers spontaneously.
Recovery
Feeling some pain is part and parcel of the healing process after surgery. Rest assured that your doctor will prescribe medications for short-term pain relief. The pain generally improves with time as your muscles and bones heal.
Paracetamol, non-steroidal anti-inflammatory drugs, and opioids are common temporary pain relief medications that will be prescribed. Your doctor might also recommend aspirin or other blood thinning medication to reduce the risk of blood clots in the veins.
You will have to use crutches for six to eight weeks after hip osteotomy whilst following instructions from your doctor on slowly increasing weight-bearing. Your orthopaedic specialist will do serial X-rays to check for healing of the bone. Most patients can return to work after three months and resume sports between six to 12 months.
