Surgery for Developmental Hip Dysplasia in Children
Doctors at NYU Langone may recommend surgery for babies who can’t be helped with nonsurgical treatment and for older children and adults who have complications of developmental hip dysplasia. Those who have tried nonsurgical treatments, or those in whom nonsurgical treatments are unlikely to offer significant improvement, have several surgical options. General anesthesia is used during all of these procedures.
Tenotomy is an outpatient surgical procedure in which the doctor loosens a tendon in the hip joint that has become too tight due to incorrect positioning. This procedure is performed before other surgeries, such as open reduction, that place the ball-shaped top of the thigh bone into the socket.
First, the surgeon uses a small needle to inject a dye into the hip joint to highlight the area on an X-ray. Then the doctor makes a tiny incision in the groin and severs a tendon in the hip called the adductor. The tendon grows back within a few months.
In open reduction, the surgeon makes a small incision in the groin and removes excess tissue to make more room in the hip socket. The surgeon then places the ball of the hip joint back into the socket. A one-night hospital stay is usually recommended after this procedure.
Hip arthroscopy is a minimally invasive procedure that is often performed to repair torn cartilage—a common complication of untreated developmental hip dysplasia in adults. In this procedure, the surgeon makes a small incision in the hip and inserts a tiny camera that is attached to a narrow tube called an arthroscope.
Hip arthroscopy allows the doctor to obtain a detailed view of the hip joint while repairing the cartilage. This is often performed during another surgical procedure, osteotomy, in which the surgeon deepens the hip socket and realigns the thigh bone, or femur. Recovery from this procedure usually takes four to six weeks.
Osteotomy is a type of surgery that may be used to deepen the hip socket and realign the thigh bone. Different approaches may be used, depending on your age and type of problem caused by developmental hip dysplasia.
A procedure known as a periacetabular, or Ganz, osteotomy is the most common and effective surgery for adolescents and adults with developmental hip dysplasia. In this procedure, the surgeon makes an incision in the front of the hip to reach the joint, cutting into the pelvic bone to free the hip socket from the pelvis. The surgeon then rotates the socket so that it aligns properly with the ball at the top of the thigh bone. Metal plates and screws are used to hold the socket in place.
Another approach, called femoral osteotomy, may be used to realign the thigh bone within the socket in adolescents and adults with limited hip mobility due to developmental hip dysplasia. During this procedure, the surgeon cuts and changes the angle of the thigh bone. Internal pins and plates may be used to hold bones in place as they heal but are usually removed after several months.
Children and adults who undergo an osteotomy may need to remain in the hospital for up to three nights.
Hip replacement surgery is a treatment of last resort that may be recommended for adults when developmental hip dysplasia cannot be effectively treated with hip-preserving techniques.
Orthopaedic specialists at NYU Langone have extensive experience performing this surgery. Our doctors can discuss different hip replacement options and surgical techniques that may be beneficial to you. They can also explain what you can expect during the recovery process, which may include physical therapy.
Our doctors may prescribe medications and physical therapy to relieve pain and to help you regain mobility and strength after surgery.
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