I spoke in a previous post (10 September) of the difficulties in diagnosing hip dysplasia, but why the need to diagnose promptly? Here are the reasons:
1.) Relationship between Dysplasia and OA
There is a lot of evidence linking hip dysplasia to early development of hip osteoarthritis (OA) (Gala et al, 2016; Takazawa et al, 2014; Thomas et al, 2014). The abnormal alignment of the joint causes damage to the articular cartilage to occur more quickly than in a normal hip joint.
2.) Pain and Disability
Even before the development of OA, the pain and reduced function from a dysplastic hip can be debiliating (Nunley et al, 2011). When painful hips stop a person from doing what they love and interfere with daily activities such as cooking, shopping and working, it goes without saying that this is not a fun experience for the patient.
3.) Osteotomy surgery is only an option for a limited time
In the hands of a good surgeon, hip preservation surgery in the form of osteotomy surgery can have fantastic outcomes, improved quality of life an often the ability to live an active lifestyle for up to 20 years, but only when the joint is less damaged. The joint needs to be in good condition with none or very minimal joint narrowing from OA in order for that kind of surgery to have a good chance of success (West et al, 2011; Gala et al, 2016; Coobs et al, 2015). A dysplastic hip won't stay non-arthritic forever, so the idea of "attempting conservative treatment before opting for surgery" needs to be taken with great care. A late diagnosis can potentially mean limited treatment options for the patient.
4.) There's no going back from a hip replacement
Hip replacements generally last about 15 - 20 years, but usually less long with dysplastic hips, due to hip anatomy being abnormal to begin with. There is also a limit to the amount of times they can be revised (West et al, 2011; Porsch et al, 1998; Arthritis Today, 2013). To drive this point home, once a THR has been revised once or twice, the more risk there is for the patient to have to have what's called a girdlestone procedure, where the entire femoral head is removed and the patient is left with significantly reduced mobility (Sharma et al, 2005). So it's important to think about the age of a patient if their late diagnosis leads to them ultimately requiring a THR sooner.
References
Arthritis Today (2013) The Challenge of Revision Hip Replacement Surgery, Arthritis Research UK. Accessed 17 September 2016
Coobs, B. R., Xiong, A. & Clohisy, J. C. (2015) Contemporary Concepts in the Young Adult Hip Patient: Periacetabular Osteotomy for Hip Dysplasia, The Journal of Arthroplasty. Vol. 30
Gala, L., Clohisy, J. C. & Beaule, P. E. (2016) Hip Dysplasia in the Young Adult, The Journal of Bone & Joint Surgery. Vol. 98-A (1)
Nunley, R. M., Prather, H., Hunt, D., Schoenecker, P. L. & Clohisy, J. C. (2011) Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients, The Journal of Bone & Joint Surgery. 93-A (2)
Sharma, H., Dreghorn, C. R. & Gardner, E. R. (2005) Girdlestone resection arthroplasty of the hip: Current perspectives, Current Orthopaedics. Vol. 19 (5)
Takazawa, M., Nakamura, J., Abe, I., Ohtori, S., Watanabe, A., Sato, Y., Sasho, T., Orita, S., Suzuki, M., Motoori, K., Masuda, Y., Takahashi, K. & Kishida, S. (2014) Predictive factors for acetabular labral lesions in osteoarthritis of the hip with radial magnetic resonance imaging--a cross-sectional study, Modern Rheutamology. Vol. 24 (6)
Thomas, G. E. R., Palmer, A. J. R., Batra, R. N., Kiran, A., Hart, D., Spector, T., Javaid, M. K., Judge, A., Murray, D. W., Carr, A. J., Ardeen, N. K. & Glyn-Jones, S. (2014) Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study, Osteoarthritis and Cartilage. Vol. 22
West, S. & Sutherland, D. (2011) A guide for adults with Hip Dysplasia: a patient's guide. Australia: Sutherland Studios
