I've been updating this blog to include recent revelations. It's nowhere near ready yet, but I thought I'd publish a post today.
I'm writing this because it's beginning to hit me more, I mean the long term consequences of hip dysplasia - particularly when not appropriately diagnosed or treated (which for many it isn't). It's been sinking in more how this will affect me now and in the future.
I'm writing this because it's beginning to hit me more, I mean the long term consequences of hip dysplasia - particularly when not appropriately diagnosed or treated (which for many it isn't). It's been sinking in more how this will affect me now and in the future.
Sometimes as a patient I have felt placated. There are obviously patients who are in far more serious circumstances than this, however the long term consequences of DDH not being treated correctly are quite serious.
You know the picture; a patient in their 60s or70s presents with back pain. You've seen their MRI report and it makes for some pretty detailed bed-time reading. But there's no way you're going to start talking to them about the disc bulge at L4, stenosis in L3, facet joint calcification in L2, 3, 4 and 5 and hypertrophic changes to the ligaments. That would freak them out Trying to address this surgically would be completely unnecessary and trying to address each one in turn would blow anyone's mind with the complexity. For somebody of that age you would call it "degenerative changes" and have them doing an exercise routine to increase stability and flexibility around the lumbar spine. You would approach it in such a way as to maintain or increase their function as much as possible, for as long as possible for somebody of that age. This can help enourmously as the soft tissue structures around the spine can support the joint itself, improving symptoms, function and quality of life for as long as possible. This won't change the degeneration that will still occur in those joints, but that is okay for somebody of that age. Certainly for somebody with Hip OA you can delay the necessity for a THR for some time using the same approach.
For somebody of a younger age with DDH - and I'm talking 20s or 30s - addressing the structural abnormality from purely a conservative perspective may well delay the necessity for surgery, but after some time, as the joint deteriorates anyway, there is less likelihood of an osteotomy being successful, and more likelihood of a THR being the only option. If this then results in them having to have a THR sooner, there may be
only a certain number of times that can be revised.
This is a different way of thinking to what we're often taught as student physios: "everyone has structural abnormalities, they don't necessarily need to be addressed surgically." It has felt like physios are always going to be more likely to push for conservative treatment. But in this case the age of the patient and the nature of the condition needs to be taken into account.
This is a different way of thinking to what we're often taught as student physios: "everyone has structural abnormalities, they don't necessarily need to be addressed surgically." It has felt like physios are always going to be more likely to push for conservative treatment. But in this case the age of the patient and the nature of the condition needs to be taken into account.
It obviously goes without saying that medicine is advancing all the time, and hip replacements can last longer than they used to. But the thing is, on more than one occasion I have felt spoken to like I'm the first kind of patient. This has led me to think about DDH like it's a long term condition, but not fully understand the consequences further down the line. I don't know if those who speak to me like this have assumed that I do have the right understanding of these consequences - if they assume it was all explained to me at the beginning (which it wasn't) or if they themselves just don't really know either. In my frustration I'm beginning to believe it is the latter.
