Hip osteotomy is a procedure used to treat hip dysplasia or select cases of osteoarthritis – a progressive condition where the cartilage in the hip joint degenerates over time. This leads to symptoms such as pain, stiffness, and difficulty with everyday movements like walking or bending. Osteotomy realigns the bones in the hip joint to reduce pain, improve the joint’s range of motion, and slow down further joint damage.
Recognising the Symptoms of Hip Osteoarthritis
Hip osteoarthritis occurs due to the gradual breakdown of cartilage in the hip joint, leading to bone-on-bone friction, joint inflammation, and progressive discomfort. Symptoms often worsen over time and include:
Pain in the Hip or Groin
Pain typically starts as a mild ache and intensifies with physical activity, making daily tasks such as walking or bending uncomfortable.
Stiffness and Limited Range of Motion
Stiffness, particularly after periods of inactivity (e.g., sitting or sleeping), can limit joint movements, such as bending, turning, or rotating the hip.
Grinding or Clicking Sensation
The loss of cartilage may cause a grinding or clicking feeling during hip movement, indicating bones rubbing against each other.
Weakness in the Hip or Leg
Muscle weakness around the hip can develop over time, affecting stability and increasing the risk of falls. This may also contribute to difficulty with weight-bearing activities.
When is Osteotomy Recommended for Hip Dysplasia?
For mild to moderate hip dysplasia, non-surgical treatments such as physical therapy, medications, or lifestyle modifications may help manage symptoms. However, osteotomy may be recommended in these situations:
Persistent Symptoms
When non-surgical options fail to relieve significant pain or improve joint function.
Joint Misalignment
If anatomical abnormalities cause uneven wear on the joint, leading to discomfort.
Younger, Active Patients
Osteotomy is often suitable for younger, more active individuals who wish to delay a total hip replacement.
The decision for osteotomy involves a thorough evaluation of the severity of osteoarthritis, joint alignment, and overall health.
Types of Osteotomy Procedures
The type of surgery is determined by individual anatomical factors and the location of the joint damage.
Periacetabular Osteotomy (PAO)
This procedure realigns the hip socket (acetabulum) to provide better coverage of the femoral head, reducing pain and pressure on the joint. It is particularly beneficial for early-stage osteoarthritis and hip dysplasia and helps preserve hip function.
Femoral Osteotomy
This surgery reshapes or realigns the femur to address deformities that cause uneven weight distribution within the joint. By correcting these issues, femoral osteotomy can alleviate pain and help slow the progression of osteoarthritis.
The Procedure
Osteotomy for hip dysplasia typically takes 2-3 hours, depending on the type of osteotomy and degree of joint misalignment being corrected.
Preparing for Osteotomy Surgery
An osteotomy requires proper preparation to ensure a smooth surgery and optimal recovery.
Medical Evaluation and Imaging
Your doctor will begin by thoroughly reviewing your medical history to ensure you are a good candidate for the procedure. They will also order imaging tests, such as X-rays or MRIs, to get a detailed view of your hip joint and assess the extent of damage and misalignment.
Medication Adjustments
Some medications, especially blood thinners, may need to be temporarily stopped to reduce the risk of bleeding during surgery. Discuss all the medications and supplements you are taking, so your doctor can give you specific instructions.
Fasting Guidelines
You will likely be instructed not to eat or drink anything after midnight on the night before your surgery. This is to avoid anaesthesia-related complications.
Step-by-step Procedure
Anaesthesia
Patients are placed under general anaesthesia to ensure they are unconscious, pain-free and immobile throughout the procedure.
Incision and Bone Reshaping
For Periacetabular Osteotomy (PAO): the surgeon makes an incision near the hip to gain access to the pelvic bone and reposition the hip socket for better joint coverage. This realignment reduces pressure on the hip joint, helping to alleviate pain and improve function.
For Femoral Osteotomy: the surgeon makes an incision along the thigh to access the femur and reshape or realign it. This correction helps balance the weight distribution across the hip joint and slows down the progression of osteoarthritis.
Realignment and Fixation
Once the bones are realigned into their new positions, they are secured using metal screws or plates to keep them stable while they heal. These fixations hold the bones firmly in place, ensuring that the corrections remain intact as the bones fuse together.
Closure
The surgical incision is carefully closed with sutures or staples. A sterile dressing is then applied over the incision site to protect it from infection.
Recovery and Rehabilitation
Recovery from osteotomy requires using crutches or assistive devices for several weeks to avoid putting weight on the hip, while pain and swelling are managed with medication and ice. Physical therapy starts soon after surgery to rebuild strength and mobility, and activities are gradually resumed over 3 to 6 months. Follow-up appointments and imaging monitor healing, with full recovery potentially taking up to a year.
Potential Risks and Complications
Osteotomy carries some risks, but taking precautions and adhering to post-operative guidelines can help minimise these complications and support recovery. Potential risks include:
Infection: Infection may occur at the incision site, usually indicated by redness, warmth, pain, or discharge. Keeping the area clean and adhering to wound care instructions can help prevent infection.
Nerve or Blood Vessel Injury: In rare cases, nerve or blood vessel damage may occur, resulting in numbness or weakness in the leg.
Blood Clots: Blood clots may develop in the legs post-surgery. Blood thinners and gentle leg exercises may be prescribed to reduce this risk.
Delayed Bone Healing: In some cases, bones may take longer to heal. Adhering to weight-bearing restrictions is necessary to ensure proper bone fusion.
Loss of Hip Range of Motion: Joint stiffness and limited joint movement may develop if physical therapy is not followed. Regular rehabilitation exercises are necessary for restoring mobility.
Conclusion
Osteotomy is a specialised procedure indicated in some patients with severe pain from hip dysplasia, particularly for those seeking to alleviate pain, improve mobility, and postpone the need for a total hip replacement. Learning about the symptoms, treatment options, and recovery process can help you make an informed decision about your joint health.
Schedule a consultation with Dr Wang Lushun to determine if osteotomy is the right solution for you and explore personalised treatment options.
