Review Question - QID 216533

The patient is presenting with symptomatic adult hip dysplasia that has persisted despite conservative treatment. A periacetabular osteotomy would correct the structural abnormality of her pelvis and reduce the risk of early-onset osteoarthritis.

Adult hip dysplasia is the manifestation of abnormal acetabular development leading to deficient anterior and lateral femoral head coverage. There are several reported risk factors including breech birth, female sex, and family history of the condition. Initial management of symptomatic patients can consist of a course of physical therapy. However, given the abnormal anatomy future, surgical treatment is common and consists of pelvic osteotomies (such as periacetabular) or total hip arthroplasty in patients with degenerative changes.

Weinstein et al. provided an instructional course lecture on developmental hip dysplasia and dislocation. They stressed the importance of understanding the normal growth and development of the hip and the causes of abnormal development to appropriately treat these conditions.

Parvizi et al. retrospectively reviewed a series of 41 patients with a previous periacetabular osteotomy that were treated with total hip arthroplasty. They reported THA provided significant pain relief but 24 patients required a trochanteric osteotomy for exposure due to abnormal proximal femoral anatomy. They concluded with careful considerations THA can be safely performed in patients with previous periacetabular osteotomies.

Figure A is an AP pelvis radiograph with bilateral hip dysplasia with decreased femoral head coverage.

Incorrect answers:
Answer 1: An MRI arthrogram is the study of choice to evaluate for a suspected labral tear. However, this should be pursued when there has not been a response to conservative treatment.
Answer 3: The patient has failed a course of physical therapy and is at risk for developing arthritis due to the dysplastic acetabulum.
Answer 4: Hip arthroscopy with femoral osteoplasty is a surgical treatment option for a cam lesion leading to a labral tear and is often performed with a labral debridement or repair. In the setting of hip dysplasia, hip arthroscopy is a relative contraindication as it can promote instability.
Answer 5: A diagnostic injection of the hip can be performed when the patient has failed a course of physical therapy and there is uncertainty in the diagnosis.