Adult Treatment Options
Surgeons tend to divide treatment options up into 2 main categories – operative and non-operative this is just how their brains work).
Unfortunately with DDH there is a biomechanical problem with the hips causing the problems – and mechanical problems tend to need a mechanical solution (i.e. surgical correction). However treatment for DDH in adults tends to be multi-disciplinary and involves radiologists, orthopaedic surgeons, physiotherapists and occupational therapists.
We will not discuss the intricate ins and outs of the different types of operation here. It is best that you do this with your surgeon.
This is usually in the form of tablets prescribed by your GP (or available over the counter) and also includes anti-inflammatory medication. These can help settle down any flare-ups of pain and allow you to get on with daily life. Common painkillers are paracetemol, codeine, tramadol, and common anti-inflammatory’s are ibuprofen and diclofenac. These are all generic names but you will find a combination of 2 or 3 can be great. Get your GP to prescribe you these so they can monitor and keep records of what works for you.
Steroids are strong anti-inflammatory drugs but can cause side effects if taken as tablets. They can be injected into joints where they can be effective as they are working right on the site of the inflammation. They usually only offer temporary (6-8 weeks, if they work at all) relief in DDH, but can be useful to get through difficult periods.
This is really important. With DDH, physiotherapy will not solve the underlying problem but it is beneficial pre-operatively and a vital component of post-operative care. The main benefit pre-op is to improve your core muscles. If you can master this before surgery it will make things easier afterwards. Post-op it is the single most important factor that will contribute to your recovery and return to normal life. We will revisit this later.
For exact procedures, complications and rehab you will need to ask your consultant. Every surgeon does things slightly differently.
Both the types of surgery listed below are called hip preservation procedures as they are aim to preserving your own hip joint for as long as possible.
Pelvic osteotomy – This has been used to treat DDH for over 20 years, however it is only recent that it is becoming more common. It is a major procedure and is more likely to be successful if it is done before any significant arthritis has developed. It involves making cuts in the pelvic bones (this is what osteotomy means, to break a bone for treatment purposes, as opposed to a fracture which is accidental) around the ‘socket’ side of the hip joint and re-orienting it to create a better socket using your own bone. It is usually done under general anaesthetic and involves satying in hospital for 3-7 days. Following the procedure you are likely to be on crutches for 4-8 weeks (depending on your surgeons guidelines) and then gradually build up to walking again following this. Some types of pelvic ostoeomy are; periacetabular osteotomy (PAO), chiari osteotomy, triple pelvic osteotomy, ganz osteotomy, however they are all following the same principles. For some people this may give them a long period of time without pain, however some people still go on to need a hip replacement.
Femoral osteotomy – this involves making a cut in the thigh bone and rotating the ‘ball’ part of the joint to improve the biomechanics of the joint. Like with pelvic osteotomies it involves a major procedure, a stay in hospital and then a variable amount of time non-weightbearing or using crutches afterwards. Occasionally both a femoral osteotomy and a pelvis osteotomy are done at the same time.
Total hip replacements – Sometimes the arthritis is too advanced to be able to preserve your own joint and in this case replacing the joint with a man-made one may be the best option. This is also major surgery and involves replace the socket side of the joint with an artificial cup and then on the ‘ball’ side the damaged part is removed and replaced with an artificial one that then articulates with the artificial cup. These can be either metal or ceramic or a combination of the two. It usually involves a hospital stay of 3-5 days and in most cases you will be up and walking around on your new hip in a matter of days with a frame/crutches or a stick for balance. Depending on how active you are a hip replacement can last a long time, however they are not designed to last forever and if it wears out a revision total hip replacement may need to be done. This is variable form case to case so remember to ask your surgeon about the longevity they predict for your new hip.
Arthroscopy – this is keyhole surgery and is sometimes used to assess and repair soft tissue damage around the hip joint and it can also help in diagnosis of the problem within the joint. It is usually done as a day case procedure or occasionally with an overnight stay and depending on what you have had done will depend on how long you need crutches afterwards. It is best to be guided by your surgeon on this one. It is important to realise that in hip dysplasia there is a problem with the bones around the joint and arthroscopy does not solve this problem so you may require a further procedure.