Orthopedic Hip specialist | Osteotomy of the Hip

The hip joint is formed where the round head of the thighbone (femur) joins the pelvic bone. Hip joint is extremely strong and amazingly flexible; it can bear weight and allow a wide range of movement. Deformities or change in orientation of either the pelvis or the femur can disrupt the freedom of movement of the joint and cause severe pain and discomfort. In order to correct the hip deformity, especially in younger patients, surgeon will suggest a hip osteotomy.

What is hip osteotomy?

Hip osteotomy is a surgical procedure to correct the deformity of hip bones. The surgeon will cut the bones of the hip joint, reshape them and will shift it into a better alignment. A healthy cartilage is placed in the weight-bearing area of the joint and thus relieving some pressure on the affected joint.

Femoral osteotomy and peri-acetabular osteotomy are the two commonly performed hip osteotomies. Femoral osteotomy is the corrective surgery performed on the ball side of the hip and peri-acetabular osteotomy is performed to correct the deformity in the curved portion of the pelvis.

Indications for hip osteotomy

The surgery is often recommended for patients who are too young for a hip joint replacement surgery. Conditions that are treated by a hip osteotomy are:

Congenital disorders such as cerebral palsy, which causes abnormal muscle contractions
Arthritis limited to a small area of hip joint
Mechanical or structural disorder of hip, such as hip impingement
Developmental dislocation of hip joint, such as hip dysplasia
Other injuries or illnesses of the hip, such as Legg-Calve-Perthes disease (childhood disorder characterized by a disrupted blood flow to the femoral head)

What are the pre-procedure care?

Surgeon will recommend imaging tests like X-ray or ultrasound scans to diagnose the extent of deformity. The surgery is planned based on the scans of the hip joint obtained from these imaging tests. Once the surgery is planned, you will be given a set of instruction to avoid complications during and after the surgery. These instructions include:

Temporarily discontinue certain medications like aspirin, ibuprofen etc.
Arrange someone to drive you back home after the surgery.
Do not eat or drink after midnight before surgery.

How is osteotomy of the hip performed?

For hip osteotomy, the patient should be admitted in the hospital one day prior to the surgery. The anesthesia team will examine the patient and will finalize the type and dose of anesthesia for the procedure. The hip osteotomy surgery is usually performed under general anesthesia which puts patient to sleep throughout the procedure.

Once the patient has been anesthetized, the surgeon will make few incisions to expose the hip joint A wedge-shaped piece of bone may be removed and moved to a new and better location within the joint. These cuts will reshape the bone to fit itself in the new position. A metal plate or screw will be inserted to fix the bone in its new place. Once the procedure is complete, surgeon will close the incision area with stitches.

What are the post-procedure care?

Hip osteotomy procedure requires a hospital stay of 4-5 days. Antibiotics and pain killers will be administered thorough an intravenous line (IV) placed in the arm vein which will be removed in 2-3 days. Patient must take complete bed rest during the hospital stay. It is important to keep the leg in an elevated position while resting to avoid swelling near the incision area. Physical therapy will begin during the hospital stay where therapist will instruct gentle exercises and also train the patient to use crutches.

To ensure a smooth recovery at home, surgeon will give the following recommendations:

Use crutches or walker to keep the hip joint from bearing the full weight of the upper body for about eight to 10 weeks.
Keep the stitches and bandages (if any) dry and clean to avoid infections.
Perform the exercises to restore movement and strengthen of your hip muscles as recommended by your physiotherapist.
Have regular follow-up visits to check the progress.

Outlook

Hip osteotomy is one of the successful correction surgeries that improve gait as well as reduce pain in the hip joint. It is widely recommended to correct some conditions like hip dysplasia and hip impingement. The surgery extends the life of hip joint in younger patients and will delay the hip replacement surgery.