Adult Hip Dysplasia

Avoid high-impact activities (running, jumping). Low-impact exercise (swimming, cycling) maintains fitness without excessive loading. Weight management critical.

Strengthen hip abductors (gluteus medius) to compensate for biomechanical disadvantage. Core stability and pelvis control. Stretching hip flexors and IT band.

NSAIDs for symptom control (avoid chronic use). Paracetamol for baseline pain. Intra-articular steroid injection can provide temporary relief and confirm intra-articular source.

Annual radiographs to monitor progression. If joint space narrows or symptoms worsen despite therapy, surgical consultation indicated.

3D CT templating for Crowe II-IV. Identify true acetabulum. Plan femoral shortening if needed. Template cup size and position. Assess bone stock for grafting needs.

Uncemented acetabular component if bone stock adequate. Consider trabecular metal for defects. Small femoral stems often required. Modular necks may aid version correction.

Posterior approach most common. Anterolateral if abductor already weak. Trochanteric osteotomy if femoral shortening required (better healing than subtrochanteric).

SSEP/MEP monitoring for Crowe III-IV cases. Lengthen under 4cm to avoid sciatic nerve palsy. Intraoperative nerve stimulation if lengthening over 3cm.

Incision from ASIS along iliac crest. Dissect interval between sartorius (femoral nerve) and tensor fascia lata (superior gluteal nerve). Subperiosteal elevation of iliacus off inner table.

Through same incision, curved osteotome directed posteriorly and inferiorly to cut ischium 10mm medial to acetabular rim. This cut exits just medial to acetabulum posteriorly.

Straight osteotome directed medially along superior pubic ramus. Exit 10mm medial to acetabular rim anteriorly. Protect obturator neurovascular bundle with retractor.

From AIIS superiorly toward SI joint (10-15cm). Incomplete posteriorly to maintain posterior column continuity. Use curved osteotome. Monitor with fluoroscopy.

Complete ischial cut with Gigli saw passed from intrapelvic to extrapelvic. Mobilize fragment with Schanz pins. Rotate laterally and anteriorly to increase coverage.

Fix with 3-4 cortical screws from ilium into mobilized fragment. Confirm hip congruity and improved CEA (target 30-35°) on fluoroscopy. Avoid overcorrection (pincer).

Standard posterior or anterolateral approach. Identify true acetabulum (may be small and shallow). Clear fibrous tissue and pulvinar from floor.

Ream to true anatomic center (teardrop reference). May need to medialize slightly. Start with small reamers. Preserve bone stock. Avoid superior placement (high hip center).

Target 40-45° inclination, 15-20° anteversion. May need smaller cup than templated. Achieve press-fit if possible. Screw fixation for deficiency. Monitor version carefully.

Increased femoral anteversion common in DDH. Monitor during reaming. May need to compensate with cup anteversion. Narrow canal may require small stems or size down.

Trial reduction. Check leg length (avoid overlengthening). Assess stability. Confirm version alignment. Check offset restoration for abductor function.

Implant definitive components. Confirm offset, length, stability. Close in layers. Consider abduction brace if stability concerns.

3D CT planning mandatory. Identify true acetabulum. Calculate required shortening. Template subtrochanteric osteotomy level. Plan for nerve monitoring.

Extended posterior approach. May need trochanteric osteotomy for exposure. Clear false acetabulum soft tissue. Identify true acetabular floor (teardrop level).

Ream true acetabulum. Often need bone grafting for superior deficiency. Use femoral head autograft. Fix with screws. Cup may be smaller than contralateral side.

Transverse or oblique cut 5-7cm below lesser trochanter. Remove 3-5cm bone segment. Trial femoral component. Adjust shortening to allow reduction without tension.

Long stem bridges osteotomy site. Cerclage wires or cables for rotational stability. Bone graft at osteotomy site. May need plate in very unstable cases.

If using neuromonitoring, confirm no signal changes. Check leg lengthening (should be under 4cm). Document sciatic nerve examination immediately postop.

Touch weight-bearing with crutches. DVT prophylaxis (enoxaparin or rivaroxaban). Pain control with multimodal analgesia. Early mobilization to prevent stiffness.

Touch to 25% weight-bearing. Gentle hip ROM exercises. No active hip flexion against gravity (protects iliopsoas). Continue crutches. Monitor for signs of nonunion.

Increase to full weight-bearing if radiographs show healing. Formal physical therapy for abductor strengthening. Progress to single crutch then cane. Return to activities of daily living.

Full weight-bearing without aids. Progress to impact activities. Return to work (desk job 6-8 weeks, manual 3-4 months). High-impact sports delayed to 12 months.

Annual radiographs for 5 years to monitor for arthritis progression. Low-impact exercise encouraged. Watch for loss of ROM or recurrent pain (suggests progression).

Mobilize same day if stable. Weight-bearing as tolerated (modern implants allow immediate). Hip precautions if posterior approach (avoid flexion over 90°, adduction, internal rotation).

Progress to cane or no aids. Physical therapy for gait training and strengthening. Continue hip precautions for 6 weeks (posterior approach). DVT prophylaxis (aspirin or anticoagulant).

Full weight-bearing, discontinue aids. Progress strengthening. Return to low-impact activities (walking, swimming, cycling). May drive at 6 weeks if off narcotics.

Return to work and most activities. Avoid high-impact sports (running, jumping). Annual radiographs to monitor for loosening or wear. Expect 95% improvement by 6 months.