If conservative measures to treat hip dysplasia remain unsuccessful or if the deformity is recognized too late (in children who are three years old or older, or in adolescents or adults), surgery is necessary. Various operative procedures are available for this.
Unlike babies, adults with hip dysplasia have no choice but to undergo surgery. This is because the malposition of the hip joint must be corrected to prevent further damage to the joint. There are various surgical procedures that aim to better "fit" the femoral head into the socket and thus achieve the most natural joint position possible. The earlier hip dysplasia is detected, the easier and more effective the therapy. As long as the joint does not show any arthrotic changes, the chances of a prosthesis-free life are very high. When wear begins, it is quite possible to delay the need for an endoprosthesis for 10 to 15 years, or even longer. In adults, hip dysplasia is usually easy to diagnose using an x-ray. Here the shape and position of the hip joint can be clearly recognized and whether there is already arthrosis of the hip. The success of the surgical treatment of hip dysplasia in adults largely depends on how badly the hip joint is already damaged. If the arthrosis has not progressed so far, surgery can significantly alleviate the symptoms. With severe signs of wear, however, an artificial hip joint is often the only way to live as an adult with hip dysplasia without pain in the long run. Based on a questioning of the patient's symptoms (anamnesis) and a physical examination, the doctor can assess the severity of the complaints in order to choose the right treatment method.
There are basically two operational strategies:
- A joint-preserving operation
- A joint replacement with an artificial hip joint (endoprosthesis)
A joint-preserving surgical intervention is usually carried out in patients whose ailments can be attributed to various pre-arthrosis in childhood. In the case of early hip arthrosis, these surgical procedures often succeed in delaying the progression of the disease for a certain period of time. The basic idea behind the joint-preserving surgical procedure is to change the malposition surgically so that the natural joint position is restored as well as possible. One hopes to slow down cartilage loss at least in the long term. During the operation, an attempt is made to turn the femoral head in the socket in such a way that areas where there are selective pressure peaks are relieved. If the load can be distributed over a larger joint surface of the femoral head and socket, the rapid loss of cartilage is accordingly slowed down. The aim of a conservative operation is to create a distribution of the acting joint pressure over the largest possible joint surface. In individual cases, the chances of success of these interventions cannot always be predicted exactly, however, extensive post-treatment is necessary. The physiotherapeutic exercises must be carried out consistently and regularly in order to achieve therapeutic success. The operation also results in an optical “artificial leg shortening” on one side. Which must then be compensated for by appropriate measures.
Triple osteotomy (joint-preserving surgery)
If an adult is diagnosed with severe hip dysplasia, the triple osteotomy is usually used as an operation. This operation is known as a joint-preserving intervention by doctors. The triple osteotomy was specially developed for the therapy of hip dysplasia. However, it is often unclear whether a three-dimensional correction of the pan is suitable and the only way to treat a malposition. Since this operation can cause serious complications, most patients always think twice before whether the procedure is really the only surgical option. Because with the triple osteotomy, the ilium, as well as the pubic bone and the ischium are severed. Then the pan is brought into the correct position and finally screwed on again. With triple osteotomy, there is always the question of whether this complicated and serious operation is necessary or whether the simpler hip TEP is the treatment of choice and thus the second real treatment alternative.
The artificial hip joint is an endoprosthesis and is called TEP (total endoprosthesis). TEP is most commonly used by all endoprostheses in medicine and is the most widely used surgery in orthopedics. Both a part of the thigh and a part of the hip bone are replaced - that is, a complete restoration of the joint. With a successful intervention, an almost complete function and possibility of movement of the hip can be achieved. The materials used must therefore meet the highest requirements. Good lubricity with minimal friction and low abrasion is important. That is why two different materials are used for the artificial femoral head and the acetabulum. These are high-strength alloys made of different metals for the head replacement and for the socket replacement, ceramic or special plastic. The size of the selected endoprosthesis must be adapted to the nature of the patient.
Surgical technique with an artificial hip joint
The new acetabular cup can usually be easily screwed into the hip bone. To achieve enough stability of the new femoral head, the new head must be added to the thigh bone together with a long shaft. The old, worn femoral head is removed during the operation and a cavity is created in the middle of the thigh bone using suitable tools. The stem of the new femoral head is inserted into it. There are basically three methods of attaching the endoprosthesis. Which one is used depends on the individual circumstances. In order to achieve the greatest possible stability and quick loading, the endoprosthesis can be attached with bone cement. The second option is a fixation without cement - here the stem is cemented in and the cup is implanted without cement.
Hip dysplasia surgery aftercare
An x-ray is checked six weeks after the hip dysplasia operation. If the result is positive, you can finally sit again from this point in time and start spreading the operated leg. This spreading trains the muscles that serve to stabilize the hip and are responsible for the gait later on.
A second follow-up is carried out a further six weeks later. If everything is OK here, you can start building muscle and stress under physiotherapy guidance. Starting with a 10kg load and adding a further 10kg weekly, you should finally come back to full load. One should pay attention to doing intensive muscle building training. Ideally, even in the course of a rehabilitation, in which further exercises in muscle building can be carried out under supervision.
Depending on the degree of wear of the joint, a hip joint endoprosthesis can also be considered.