A hip osteotomy is a surgical procedure in which the bones of the hip joint are cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the weight-bearing area of the joint, followed by reconstruction of the joint in a more normal position.
To understand hip surgery, it is helpful to have a brief description of the structure of the human hip. The femur, or thigh bone, is connected to the knee at its lower end and forms part of the hip joint at its upper end. The femur ends in a ball-shaped piece of bone called the femoral head. The short, slanted segment of the femur that lies between the femoral head and the long vertical femoral shaft is called the neck of the femur. In a normal hip, the femoral head fits snugly into a socket called the acetabulum. The hip joint thus consists of two parts, the pelvic socket or acetabulum, and the femoral head.
The hip is susceptible to damage from a number of diseases and disorders, including arthritis, traumatic injury, avascular necrosis, cerebral palsy, or Legg-Calve-Perthes (LCP) disease in young patients. The hip socket may be too shallow, too large, or too small, or the femoral head may lose its proper round contour. Problems related to the shape of the bones in the hip joint are usually referred to as hip dysplasia. Hip replacement surgery is often the preferred treatment for disorders of the hip in older patients. Adolescents and young adults, however, are rarely considered for this type of surgery due to their active lifestyle; they have few good options for alleviating their pain and improving joint function if they are stricken by a hip disorder. Osteotomies are performed in these patients, using the patient's own tissue in order to restore joint function in the hip and eliminate pain. An osteotomy corrects a hip deformity by cutting and repositioning the bone, most commonly in patients with misalignment of certain joints or mild osteoarthritis. The procedure is also useful for people with osteoarthritis in only one hip who are too young for a total joint replacement.
The incidence of hip dysplasia is four per 1,000 live births in the general world population, although it occurs much more frequently in Lapps and Native Americans. In addition, the condition tends to run in families and is more common among girls and firstborns. Acetabular dysplasia patients are usually in their late teens to early thirties, with the female: male ratio in the United States being 5:1.
A hip osteotomy is performed under general anesthesia. Once the patient has been anesthetized, the surgeon makes an incision to expose the hip joint. The surgeon then proceeds to cut away portions of damaged bone and tissue to change the way they fit together in the hip joint. This part of the procedure may involve removing bone from the femoral head or from the acetabulum, allowing the bone to be moved slightly within the joint. By changing the position of these bones, the surgeon tries to shift the brunt of the patient's weight from damaged joint surfaces to healthier cartilage. He or she then inserts a metal plate or pin to keep the bone in its new place and closes the incision.
There are different hip osteotomy procedures, depending on the type of bone correction required. Two common procedures are:
A physical examination performed by a pediatrician or an orthopaedic surgeon is the best method for diagnosing developmental dysplasia of the hip. Other aids to diagnosis include ultrasound examination of the hips during the first six months of life. An ultrasound study is better than an x ray for evaluating hip dysplasia in an infant because much of the hip is made of cartilage at this age and does not show up clearly on x rays. Ultrasound imaging can accurately determine the location of the femoral head in the acetabulum, as well as the depth of the baby's hip socket. An x-ray examination of the pelvis can be performed after six months of age when the child's bones are better developed. Diagnosis in adults also relies on x ray studies.
To prepare for a hip osteotomy, the patient should come to the clinic or hospital one to seven days prior to surgery. The physician will review the proposed surgery with the patient and answer any questions. He or she will also review the patient's medical evaluation, laboratory test results, and x-ray findings, and schedule any other tests that are required. Patients are instructed not to eat or drink anything after midnight the night before surgery to prevent nausea and vomiting during the operation.
Immediately following a hip osteotomy, patients are taken to the recovery room where they are kept for one to two hours. The patient's blood pressure, circulation, respiration, temperature, and wound drainage are carefully monitored. Antibiotics and fluids are given through the IV line that was placed in the arm vein during surgery. After a few days the IV is disconnected; if antibiotics are still needed, they are given by mouth for a few more days. If the patient feels some discomfort, pain medication is given every three to four hours as needed.
Patients usually remain in the hospital for several days after a hip osteotomy. Most VRO patients also require a body cast that includes the legs, which is known as a spica cast. Because of the extent of the surgery that must be done and healing that must occur to restore the pelvis to full strength, the patient's hip may be kept from bearing the full weight of the upper body for about eight to 10 weeks. A second operation may be performed after the patient's pelvis has healed to remove some of the hardware that the surgeon had inserted. Full recovery following an osteotomy usually takes longer than with a total hip replacement; it may be about four to six months before the patient can walk without assistive devices.
Although complications following hip osteotomy are rare, there is a small chance of infection or blood clot formation. There is also a very low risk of the bone not healing properly, surgical damage to a nerve or artery, or poor skin healing.
Full recovery from an osteotomy takes six to 12 months. Most patients, however, have good outcomes following the procedure.
One alternative is to postpone surgery, if the patient's pain can be sufficiently controlled with medication to allow reasonable comfort, and if the patient is willing to accept a lower range of motion in the affected hip.
Surgical alternatives to a hip osteotomy include:
See also ; Hip replacement ; Hip revision surgery .
Callaghan, J. J., A. G. Rosenberg, and A. E. Rubash, eds. The Adult Hip , 2 vols. Philadelphia, PA: Lippincott Williams & Wilkins Publishers, 1998.
Klapper. R., and L. Huey. Heal Your Hips: How to Prevent Hip Surgery—and What to Do If You Need It . New York: John Wiley & Sons, 1999.
MacNicaol, M. F., ed. Color Atlas and Text of Osteotomy of the Hip . St. Louis, MO: Mosby, 1996.
Devane, P. A., R. Coup, and J. G. Horne. "Proximal Femoral Osteotomy for the Treatment of Hip Arthritis in Young Adults." ANZ Journal of Surgery 72 (March 2002): 196-199.
Ganz, R., and M. Leunig. "Osteotomy and the Dysplastic Hip: The Bernese Experience." Orthopedics 25 (September 2002): 945-946.
Ito, H., A. Minami, H. Tanino, and T. Matsuno. "Fixation with Poly-L-Lactic Acid Screws in Hip Osteotomy: 68 Hips Followed for 18-46 Months." Acta Orthopaedica Scandinavica 73 (January 2002): 60-64.
Millis, M. B., and Y. J. Kim. "Rationale of Osteotomy and Related Procedures for Hip Preservation: A Review." Clinical Orthopaedics and Related Research 405 (December 2002): 108-121.
American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, Illinois 60018-4262. (847) 823-7186. http://www.aaos.org
Arthritis Foundation. P.O. Box 7669, Atlanta, GA 30357-0669. (800) 283-7800. http://www.arthritis.org .
AAOS. Legg-Calve-Perthes Disease . http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=159&topcategory=About%20Orthopaedics .
Arthritis Foundation. Types of Surgery . http://www.arthritis.org/conditions/surgerycenter/types.asp .
MedlinePlus. Developmental Dysplasia of the Hip . http://www.nlm.nih.gov/medlineplus/ency/article/000971.htm .
Monique Laberge, Ph.D.
A hip osteotomy is performed in a hospital by surgeons who specialize in the treatment of hip disorders, such as reconstructive orthopedic surgeons, pediatric orthopedic surgeons, and physiatrists.
To answer your questions, after the anesthesia is gone, the pain is very tolerable. Now that it has been five years since my surgery I feel a bit of an arthritis feeling in my lower back and hips when its humid outside but it's nothing a Tylenol won't help. Before I had the surgery, it was said that I might have to have the same surgery on my right hip too, but having it on my left hip aligned my right one and it wasn't necessary.
I couldn't imagine how my life would be without having the hip osteotomy surgery. It is said that if I chose not to have the surgery then I would be in a wheelchair by the time I hit 50. I would rather deal with the back pain then be immobile. I am very active and only somethings, like running for a long period, bother my hip.
Thank You;
Dawn Love
thank you a lot for the article. i learned a lot.
i have the problem you wrote about, and the doctors said i need Pelvic osteotomy. i live in Israel;and we d'ont have here a surgeon with serious experiment in this kind of surgery.
do you know a surgeon that would be able to come to israel for us? there are some more patients like me, and we suffer a lot from this problem.
i'm waitting for your answere. thank you a lot. rachel.
although it is better now when i woke up the pain was unbearable because of this i am reluctant to have the outer one done. the other problem that i am having is although the pain in the corrected hip is now more tolerable it is still there is this normal?
So, at this point, my hips have worsened and surgery is going to have to happen. I am very glad I didn't get the arthroscopic surgery because they are now saying that because the joint is still unhealthy, there will be future tears and it will be harder to correct. So, it looks like I'm getting the big one!! Oh boy!
If anyone has information about the recovery process, I'd really really appreciate it! I am 20 right now and am freaking out about whether this is going to ruin my plans/life and if I'll graduate from college on time and all those other what-ifs! I am wondering about how long after surgery could I attend classes, how much pain am I going to be in, how long do you stay in the hospital, how long after doing the right one can I do the left one? If anyone can give me some information, that'd be great!
I went through physical therapy, and they said it was Structural not Mechanical. I have not gone back to the Doctor who did the surgery because he is specific for children.
I am curious if anyone has had this surgery and is having the same problems as I am? I really do not know what to do. I have not had any children and would like to have children, but there is no way I can gain weight on this hip.
As far as one side being longer than the other, that can be corrected with a shoe build up or lift in some cases. I went through the same thing with my right hip but ended up having the surgery redone by another surgeon. The key is finding a really good surgeon who knows what they're doing. ;-)
I would recommend you to contact Michael B. Millis , MD who is performing very specific type osteotomy - PAO, which can be solution for adult hip dyspepsia patient.
Best!
I need to make a decision wether to have that operation or wait and have a hip replacement in a few years time