Lecture on Hip Anatomy and Surgical Procedures

Anatomy of the Hip

• Femoral Head: Ball-shaped structure at the top of the femur.
• Acetabulum: Socket in the pelvis that accommodates the femoral head.
• Both structures are covered with articular cartilage to minimize friction.

Hip Dysplasia

• Prevalence: Affects about 1 in 20 people to some degree.
• Severe Cases: 2-3 out of every 1000 require treatment.
• Issue: Acetabulum doesn't fully cover the femoral head.
• Symptoms: Hip pain, restricted motion, limp, especially after years of stress.
• X-ray Findings: Shallow acetabulum with outward angle.
• Consequences: Stress on muscles, ligaments, labrum, and cartilage leading to pain.

Osteoarthritis and Hip Dysplasia

• Progression: Leads to thinning of cartilage, causing bone-on-bone contact.

Periacetabular Osteotomy (PAO)

• Purpose: Corrects acetabular dysplasia.
• Procedure:
  • Cuts acetabulum from pelvic bone.
  • Repositions it to support the femoral head better.
  • Aims to improve function, alleviate pain, and delay/prevent osteoarthritis.
  • Preserves natural hip joint, potentially delaying/eliminating need for hip replacement.

Surgical Procedure

• Pre-operative Steps: Meeting with surgical team, IV insertion, and compression stockings.
• Anesthesia: Regional anesthesia with an epidural catheter.
• Operation:
  • Consists of cutting pelvic bones to reorient acetabulum.
  • Usually takes 2.5 to 3.5 hours.
  • Incision of 4-6 inches.
  • Bones are cut using specialized tools and repositioned.
  • Temporary screws and wires stabilize repositioned acetabulum.
  • Final screws secure the acetabulum.
  • Bone graft material may be added to facilitate healing.
• Closure: Superficial muscles reattached, and skin sutured.

Recovery and Post-Operative Care

• Hospital Stay: 2 to 4 days.
• Pain Management: Epidural catheter for 24 hours post-op.
• Mobility:
  • Use of crutches or walker with 20% weight bearing.
  • Gradual reduction in swelling, bruising, and numbness.
  • Compression stockings and medication reduce risk of blood clots.
  • Physical therapy begins after 6-week consultation.
  • Walking unaided typically permissible 2 to 3 months post-op.

Outcomes

• Improvement: Significant reduction in pain and improved function.
• Activity: Fewer restrictions compared to total hip replacement; possible return to sports without pain.
• Follow-up: X-rays show improved joint orientation and decreased pressure on the acetabulum.