To determine if treatment and surgery using hip osteotomies is best for you or your child, your doctor will consider important factors including age, present health, health history, the extent and location of the dysplasia and past history with other medications and treatments. A hip osteotomy is a surgery done primarily on adolescents that involves reshaping the hip bone and cartilage so that the healthier cartilage is placed in the areas that bear the most weight, making the bone and joint stronger overall. In some cases, elderly patients have these surgeries instead of hip replacements.
A hip osteotomy can be an important surgical procedure for children with hip dysplasia or the elderly who may need the help of reconstruction to strengthen their bones. If you have any reason to believe you or your child may be a candidate for this procedure, it is important to seek medical attention. As the doctor makes a diagnosis, a physical exam will be performed and you will be asked questions about activity and symptoms. To determine if this is the right procedure, the following techniques will be used:
- Ultrasound – An ultrasound uses sound waves to create images that can give a doctor a better image of the bone in the area. This is done on children under the age of six months because their bones are not yet fully developed; this method is preferred for younger children because X-rays can be more difficult to read in children of this age.
- X-ray – In anyone over the age of six months, an X-ray is the preferred method of diagnosis. This is done by sending radiation through the body. The bone absorbs the radiation and an image is created in black and white based on this absorption.
- Computer tomography scan (CT or CAT scan) – This is sometimes used to generate a more detailed image of the joint. It combines X-ray technology with computer technology to create a three-dimensional image.
- Magnetic resonance imaging (MRI) – An MRI is used to get another image of the structures inside the patient’s body. This test does not use radiation, unlike X-rays and CAT scans, and so is sometimes the preferred method. It uses magnetic waves to send vibrations into the body. This resonance is then translated into an image.
When hip osteotomies are performed, surgery is required, as the procedure involves opening up the hip joint to move the cartilage around. However, in some cases nonsurgical approaches may be used to improve hip dysplasia. These include treatments such as a harness or brace. However, it is important to consider that not having surgery can result in significantly reduced hip mobility, which can affect the patient’s quality of life. It is always important to discuss these options with your doctor to find the best treatment for your child.
Hip osteotomies involve replacing weak cartilage with stronger cartilage. The goal of most hip osteotomy surgeries is to strengthen the hip joint so that the strongest cartilage does most of the weight-bearing activities. Most hip osteotomies are done using the following techniques:
- Varus rotational osteotomy (VRO) – This type of osteotomy is done around the femoral head, which is the ball in the ball-and-socket joint that articulates the hip. This technique is used to correct the shape of the femoral head and how it fits into the hip joint, allowing for strong movements.
- Pelvic osteotomy – This type of osteotomy is done to strengthen the bone in the hip joint that surrounds the femoral head. This bone must support the movement and correct operation of the femoral head, which requires strong cartilage in this area. When a pelvic osteotomy is performed, it replaces the cartilage in this area with stronger cartilage so that the hip joint can be supported.
- Dega osteotomy – This procedure involves the nerves and muscles surrounding the hip. It is similar to the pelvic osteotomy but also corrects some of the muscles and nerve endings. The pelvis is bent downwards in this surgery, and bone graft is used to fill in the gap. This bone graft eventually attaches to the bone.
A portion of the research surrounding hip osteotomies is on how to prevent future arthritis in children who receive this treatment. This surgery is performed on many children who have hip dysplasia, a disease that often leads to osteoarthritis down the road. While the surgery is a great way to fix the symptoms associated with hip dysplasia, its effect on osteoarthritis remains somewhat unclear.
Hip dysplasia increases the amount of friction and stress put on the joint. Because a hip osteotomy reduces the amount of stress put on the joint and lowers the weight-bearing load on the bone, researchers hypothesize that this will lead to reduced or no symptoms of osteoarthritis.
Researchers have studied patients who have undergone a pelvic osteotomy to monitor their progression over the years following the surgery. While this research is ongoing, some studies have found that the results will be dependent on the extent of arthritis already in the joint. In severe cases, hip osteotomies are not having as much of an effect on the arthritis as researchers would like to see. Through enhanced imaging techniques, researchers are hoping to catch this condition earlier and treat it before the osteoarthritis can progress too far, making hip osteotomies more effective in children.
As research on diagnosis and treatment is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of hip experts at Northwell Health Orthopaedic Institute performs hip osteotomies surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.