I've realised that, amidst all my whining about the practicalities of post-op recovery, I haven't written much about the technicalities of what this surgery involves. Let me elaborate.
There are two types of osteotomy used to correct a shallow or abnormal acetabulum in adult hip dysplasia; the Peri-actabular Osteotomy (PAO) and the Triple Pelvic Osteotomy (TPO).
PAO
This is a PAO or Peri-acetabular Osteotomy. It's also known as a Ganz Osteotomy or Bernese Osteotomy. As you can see, part of the pelvis is cut out and this 'acetabular fragment' is manoeuvred around so that the acetabulum gives better coverage to the femoral head. This means that the weight-bearing zone of the hip joint is more effective than before. It is then held in place with screws.
Given that the acetabular fragment has been moved away from the rest of the pelvis (to a greater or lesser extent depending on the degree of dysplasia) the first part of recovery after a PAO is usually spent non-weight-bearing, as there isn't quite enough stability in the pelvis, and time needs to be given to allowing more bone to grow in the space that is left. There is sometimes a risk of stress fractures, especially if weight-bearing on that joint begins too soon, however this obviously depends on the degree of correction required.
Have a look at the following by Mr Johan Witt, an esteemed surgeon in young adult hip problems:
Have a look at the following by Mr Johan Witt, an esteemed surgeon in young adult hip problems:
TPO
The Triple Pelvic Osteotomy is a slightly different way of undertaking the surgery. The surgeon I am under uses a surgery that has been developed further into what is now called the Birmingham Interlocking Pelvic Osteotomy, or BIPO. In a BIPO, the acetabular fragment is cut away from the rest of the pelvis in a shape similar to 3 sides of a 50 pence piece. These are then moved around and lined up to create a 'bony interlock' in the pelvis and cover the femoral head more fully.
The above is a representation of the acetabular fragment being turned and lined up with the rest of the pelvis. The bony interlock that is created often allows for sooner partial weightbearing of the joint post-op, as there is not such a big gap between the bone cuts. An external fixator is used (shown in yellow above) to move the fragment around, the aim of this being to help correct the alignment more precisely.
The above being said, though, everyone's case is different, because everyone's pelvis and severity of dysplasia is going to be slightly different. There are cases where a BIPO is performed and does not 'lock' into place quite as well, so the person is non-weight bearing for longer, and other cases where a someone could start partial weight-bearing much sooner after a PAO. Everyone is different.
Both these surgeries carry risks of nerve damage, blood loss, DVT or Pulmonary Embolism, infection, non-union and malposition. One of the most important parts of the surgery is the experience of the surgeon, they are both very technical surgeries with a steep learning curve. Remember the aim is to delay a THR for as long as possible. A dysplastic hip will never be absolutely perfect, but the correction needs to be as accurate as possible, and a surgeon who treats a high volume of hip dysplasia patients will inevitably have more experience and skill in doing so.
The International Hip Dysplasia Institute (2016) Hip Preservation Surgery for Adult Hip Dysplasia. Retrieved from http://hipdysplasia.org/adult-hip-dysplasia/adult-treatments/hip-preservation-surgery-for-adult-hip-dysplasia/
Both these surgeries carry risks of nerve damage, blood loss, DVT or Pulmonary Embolism, infection, non-union and malposition. One of the most important parts of the surgery is the experience of the surgeon, they are both very technical surgeries with a steep learning curve. Remember the aim is to delay a THR for as long as possible. A dysplastic hip will never be absolutely perfect, but the correction needs to be as accurate as possible, and a surgeon who treats a high volume of hip dysplasia patients will inevitably have more experience and skill in doing so.
Info taken from:
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)
Malviya, A., Dandachli, W., Beech, Z., Bankes, M. J. & Witt, J. D. (2015) The Incidence of Stress Fracture following Peri-acetabular Osteotomy, The Bone & Joint Journal. Vol. 97-B
Malviya, A., Dandachli, W., Beech, Z., Bankes, M. J. & Witt, J. D. (2015) The Incidence of Stress Fracture following Peri-acetabular Osteotomy, The Bone & Joint Journal. Vol. 97-B
O'Hara, J. N., McBryde, C. W. & Jewell, D. (2014) The Birmingham Interlocking Pelvic Osteotomy [BIPO] at 20 years. Retrieved from http://www.ishameetings.net/assets/isha/2014_ePosters/902_Ohara.pdf
The International Hip Dysplasia Institute (2016) Hip Preservation Surgery for Adult Hip Dysplasia. Retrieved from http://hipdysplasia.org/adult-hip-dysplasia/adult-treatments/hip-preservation-surgery-for-adult-hip-dysplasia/
