Bilateral Hip Dysplasia: When to Preserve, and When to Replace?

A 37-year-old female presented to Cleveland Clinic’s Department of Orthopaedic Surgery with symptomatic bilateral hip pain. Her symptoms had progressed since an injury to her right hip six months previously. Computed tomography (CT) imaging showed underlying bilateral hip acetabular dysplasia, in addition to severe arthritis of the right hip and preserved cartilage of the left hip.

Atul Kamath, MD, Director of the Center for Hip Preservation and staff surgeon in the Orthopaedic and Rheumatologic Institute, advises, “We have to look at each hip based on the quality of the cartilage that is there at the time of presentation. Her right hip was too far gone for any preservation measures, given the severe arthritis at the time.”

A staged approach

For this reason, he explains, he elected to perform arthroplasty of her right hip and, at a future date, would perform a periacetabular osteotomy of the left hip. Periacetabular osteotomy involves rotating the acetabulum, optimizing the surface for the femoral head – a procedure that can delay or prevent the progression of osteoarthritis.1

Three months after the first procedure, Dr. Kamath performed the periacetabular osteotomy on the left hip through a Smith-Petersen/direct anterior approach. The patient did well with high functional activity at final follow-up.

Watch the video case study

To view preoperative and postoperative images and learn more about the case, watch the video below. Dr. Kamath discusses the case in detail, including indications for the procedure, his surgical approach and the patient’s outcomes.

Visit Cleveland Clinic’s YouTube channel for more video case studies from Dr. Kamath and other Orthopaedic and Rheumatologic Institute surgeons.

Reference

1. Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect. 1996;45:209-26. PMID: 8727740.