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One of the conditions ultimately causing hip arthritis is dysplasia, where the socket of the pelvis isn’t deep enough, causing excess load on the rim of the socket (or acetabulum).  It is related to childhood hip dislocation, thus more likely with family history, being born breech or by caesarian section.

Peri-acetabular Osteotomy (PAO) is an operation to redirect the socket in the pelvis, reducing excessive force on the rim.  It involves cutting the socket out of the pelvis, rotating it to the correct position.  There is a healing time required and crutches, but then its all you, apart from some screws.  If the joint space is good, we will recommend PAO in younger patients.  We don’t have enough patients in Ballarat needing the surgery for one of us to be great at this operation, so it is one of the rare instances we need to refer to a colleague in Melbourne


Figure 1.  This shows centre edge of 19 degrees,the cartilage rim is then overloaded.  The best treatment is PeriAcetabular Osteotomy (PAO).  This surgery rotates the bone of the acetabulum outwards, the complication rate not significantly different than hip replacement, as published in the Bone & Joint Journal October 2015.

Figure 2. Normal centre edge angle measuring 35 degrees (Normal is more than 30 degrees).

Hip arthroscopy is a questionable procedure in hip dysplasia.  If the acetabulum is shallow, its hardly surprising the cartilage rim or labrum is overloaded, and tears. Hip arthroscopy requires an amount of bone to be removed before the labrum can be repaired to the rim, this makes the acetabulum more shallow….obviously not ideal. The October 2015 Bone & Joint Journal gives the idea some support, but success is not universal.

Other conditions which ultimately ruin the hip and require a hip replacement can also be treated at a young age. It depends on the cause of the arthritis.  If inflammatory (eg Rheumatoid, psoriatic, and others), then tablets modifying the immune system make sense.  Other conditions ultimately leading to hip osteoarthritis include dysplasia (see above), Slipped Epiphysis, and Femoro-Acetabuluar Impingement (FAI).  Before the hip is frankly arthritic, it may be possible to save it.  Hip arthroscopy is a great solution for FAI to remove the bump on the neck of the femur, and repair the torn labrum.

Mr David Mitchell