Christy was an active teenager who started to experience pain in her hip joints as an adult. When the pain began to interfere with her work as a pediatric nurse and her upcoming wedding, she turned to Dr. Richard Santore, an orthopedic surgeon affiliated with Sharp Memorial Hospital.
Patients like Christy who have hip dysplasia will often eventually need a hip replacement, as the improper alignment of the hip and leg bone damages bone structure and wears away the cartilage in the hip joint. To help Christy reduce pain and postpone or potentially eliminate the need for hip replacement surgery, Dr. Santore performed a hip osteotomy to realign Christy’s hip joint.
He recently answered a few questions about hip dysplasia and the benefits of osteotomy.
What is hip dysplasia and how common is it?
It’s best described as a glitch in the software development of the hip joint. When the hip socket isn’t properly formed, the head of the femur (long leg bone) angles up toward the front of the joint and you don’t have enough cartilage in the hip environment to distribute weight properly. Those factors contribute to false movement of the ball of the joint — clicking, snapping, grinding and moving around.
While DDH (developmental dislocation of the hip) affects less than 1 percent of the population, its consequences are responsible for close to 40 percent of total hip replacements done in the U.S., so getting to it early and correcting the architectural issues in a way that slows down deterioration of the hip has enormous benefits to the patient, and to public health.
What is the cause, and who is most affected?
During the development years — birth through age 15 or so — there are incremental changes that are set in motion by a genetically engineered glitch in the software. Eighty-five percent of patients tend to be female. Symptoms manifest themselves at various times in life, so some people know by the time they are teenagers, others not until their 30s or 40s.
Christy said she lived a normal life with normal activity and didn’t have problems until she became a runner. How common is it to live with little to no pain with this condition?
That’s entirely commonplace. A number of women will not know they have a problem until their second pregnancy. In the first, they’ll have an ache in the hip that will be written off as birth stretches, etc. In the second pregnancy, the hip becomes unstable and painful, and it doesn’t go away. There is an inherent soft tissue laxity, and the pregnancy process puts out hormones that deliberately loosen the pelvis so the birth canal can open. Those are a toxic combination.
Who is a candidate for the hip preservation procedure?
Patients with symptomatic dysplasia, activity-related pain or clicking; have little or no arthritis; and have favorable geometry predict a good outcome. Favorable geometry means that the joint is congruent and symmetrical, and that when you move the femur, it glides inside the pelvis.
How does it prevent the need for hip replacement?
Two things: it immediately results in an improved sense of well-being and a reduction in pain. Many patients tell me within a few weeks of the surgery that they feel like their hip is in the right place at the right time. Because the false movements are being controlled and there’s less pain, there’s less stress on the cartilage, so wear and tear slows down dramatically. If you combine feeling much better — in many cases feeling normal — with the fact that you’re not going to need the hip replacement for years longer than would have otherwise been the case, it becomes a very big benefit for the patient.
There’s no question that this is a game changer for hip replacement. Absent the operation, hip replacement would likely be needed a decade or two earlier.