Hip Preservation Surgery

 Hip preservation surgery is a viable alternative for treating conditions such as FAI, hip dislocation, hip dysplasia, labral tear, and avascular necrosis. The surgery encompasses different techniques such as periacetabular osteotomy, surgical hip dislocation, femoral osteotomy, and hip arthroscopy, all of which benefit young and active patients by restoring function, reducing pain, and prolonging the hip joint's life.

Periacetabular osteotomy

Periacetabular osteotomy is a surgical intervention aimed at treating hip dysplasia, which is a congenital condition that may manifest at birth or within a few months after. Patients affected by this condition have a shallow acetabulum, which causes the misalignment of the femoral head within the joint, leading to the early wearing of the joint with time.

To restore the proper functioning of the hip joint, periacetabular osteotomy can be performed. This procedure involves cutting the acetabulum from the pelvic bone, then repositioning it using screws to provide a better fit for the femoral head. This surgical technique reduces pain, restores function, and prevents further hip joint damage, thereby prolonging the life of the joint and delaying the need for total hip replacement.

Periacetabular osteotomy is typically recommended for patients aged over 10 years and young adults under the age of 40.

Hip anatomy

The hip joint is formed by the articulation of the ball-shaped head of the femur with the acetabulum of the pelvic bone. The socket is encircled by a rim of cartilage known as the labrum, which deepens the socket and enhances the stability of the joint. The cartilage covers the articulating surfaces of both the femur head and the acetabulum, enabling smooth movement between the two bones.

Hip dysplasia is a congenital hip disorder that can manifest as either a shallow acetabulum or an abnormality in the upper portion of the femur. This condition can cause symptoms such as limping, waddling, or toe-walking, and may lead to premature degeneration of the hip joint cartilage, as well as rim fractures or labral tears. Patients with hip dysplasia may begin to experience pain in the groin region between the ages of 20 to 30.

Diagnosis

The doctor may suspect hip dysplasia based on the patient's medical history, symptoms, and physical examination, and a confirmatory diagnosis can be made by an X-ray of the hip joint. An MRI scan may also be ordered to assess the condition of the labrum.

Initially, the treatment is aimed at managing the symptoms of pain and inflammation. However, surgical intervention is necessary to treat hip dysplasia, either through periacetabular osteotomy or total hip replacement. If left untreated, hip dysplasia can lead to progressive arthritis, increasing pain, and loss of hip function.

The periacetabular osteotomy is a technically challenging surgery that is performed under fluoroscopy to provide the surgeon with continuous live X-ray guidance. The procedure is carried out under general anesthesia with the patient lying on their back. An incision is made over the hip joint, and the acetabulum is separated from the rest of the pelvis using a surgical saw. The bone fragment containing the acetabulum is then rotated to a new position, covering the head of the femur more naturally. Screws are inserted into the bone to fix it in the new position, and the incision is closed using sutures and surgical staples.

In some cases, a femoral osteotomy may also be necessary to cut and reposition the femoral head, but this is only determined during the surgery itself. If required, this procedure will be done simultaneously but would require a separate incision.

Risks and complications

Although periacetabular osteotomy is considered a safe surgery, complications may occur, including non-union of bones, wound infection, deep vein thrombosis, nerve damage, and pulmonary embolism.

Following the surgery, patients are given pain and anticoagulant medications, and crutches are required for the first six weeks to prevent full weight bearing on the operated hip. X-rays are taken a few days after the surgery to confirm the new position of the acetabulum, and physical therapy is initiated promptly to improve hip function and strengthen the hip muscles. Full recovery generally takes around four months.

Compared to total hip replacement surgery, periacetabular osteotomy has several advantages for young patients with dysplastic hip, including the absence of restrictions on joint use, preservation of natural bone, avoidance of the risk of metal ion release from artificial joints in women of childbearing age, and retention of full hip sensations. Additionally, periacetabular osteotomy is a better option for young patients who would likely outlive the life of an artificial implant and would otherwise require revision surgery with its higher complication rate. However, total hip replacement can still be performed after periacetabular osteotomy if necessary.