Review Question - QID 217092

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 may reduce the risk of early-onset osteoarthritis.

Adult hip dysplasia is the manifestation of abnormal acetabular development leading to classically 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, surgical treatment may be necessary and consists of pelvic osteotomies (such as periacetabular) or total hip arthroplasty in patients with degenerative changes. Concomitant hip arthroscopy with labral reconstruction may also be performed at the time of PAO and has been used as a tool to better diagnose and treat concomitant labral pathology compared with arthrotomy. Hip arthroscopy and labral repair alone however can result in instability if the anatomic pathology is not corrected at the same time. Ultimately, given the structural abnormalities of acetabular development as well as the lack of significant arthritis, this patient would benefit most from a PAO.

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 and lack of arthritic change on the symptomatic left hip.

Incorrect Answers:
Answer 1: Total hip arthroplasty is recommended in those patients with dysplasia and advanced degenerative disease, which is not shown in this patient on the affected left hip.
Answer 2: Salter osteotomy is utilized in the treatment of pediatric dysplasia in patients with open triradiate cartilage.
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: Hip resurfacing would not be indicated in this patient as there is no evidence of degenerative disease.