PAO Preserves the Hip


CHICAGO, Ill. (Ivanhoe Newswire) — May is Arthritis Awareness month and hip dysplasia is one of the leading causes of hip arthritis. Hip dysplasia is a condition where the ball and socket joint of the hip does not properly form in utero or throughout childhood. Currently every newborn in the U.S. is examined for hip dysplasia, but if not properly diagnosed and treated, hip problems can arise years or even decades later. Ivanhoe has details on how doctors are preserving patients’ hips and reducing their need for a later hip replacement.  Periacetabular osteotomy, PAO.

Forty-one-year-old Dot Lambsheadroche works out to keep her bones healthy and strong. But growing up, that was not always easy. As a baby Dot was diagnosed with hip dysplasia.

“They caught mine when I was about 14 months when I was trying to walk,” shared Dot.

Surgery and a full-body cast helped correct Dot’s hip dysplasia. But 40 years later, Dot’s hips were bothering her so much that even walking became a hassle.

“My quality of life was such as that I was no longer able to walk. So, it became this ridiculous thing where the family would walk and then mom would drive,” Dot explained.

She tried acupuncture, massage, physical therapy, and nothing worked.

“The reason why it’s a problem is it’s one of the leading causes of hip arthritis,” said Joel Williams, MD, a hip surgeon & orthopedic trauma for Midwest Orthopaedics at Rush.

Dr. Williams recommended a periacetabular osteotomy, or PAO surgery.

“That procedure is designed to make some cuts around the hip socket and position it to a more normal location,” Dr. Williams stated.

The surgery decreases hip pain, improves hip function, and stops the damage occurring inside the joint that can lead to hip arthritis over time.

Dr. Williams continued, “The main purpose is to preserve the hip joint for as long as possible.”

For Dot, who had the surgery, that was good news.

“My pain is significantly less. I got to keep my joint,” smiled Dot.

Now this mother of three is able to keep up with her kids.

One in ten hip replacements are because of hip dysplasia. Hip dysplasia is more common in girls than in boys and some risk factors for hip dysplasia includes being the first born and being born breeched.

Contributors to this news report include: Milvionne Chery, Producer; Roque Correa, Editor; and Kirk Manson, Videographer.

REPORT #2850

BACKGROUND: Nearly 1 of every 1,000 babies is born with hip dysplasia. Girls and firstborn children are more likely to have the condition. It can occur in either hip but is more common on the left side. Hip dysplasia is an abnormality in the hip joint where the femur, or thigh bone does not fit together with the pelvis as it should. In some cases, the socket is not deep enough to hold the femoral head in place. Most people who have hip dysplasia were born with the condition, or it can develop if the baby’s position in the womb puts pressure on the hips, or it can be genetic. Hip dysplasia can damage the tissue that cushions these bones in the joint, known as cartilage. It can also cause pain and issues ranging from an unstable joint to dislocation.


HIP REPLACEMENT FOR HIP DYSPLASIA: For people between 45-50 years old, and when arthritis is severe, total hip replacement is needed for hip dysplasia. Hip dysplasia has unique features that need special techniques for the hip replacement surgery to be successful. For surgical planning, hip dysplasia is usually classified from mild to severe with Type 1 being the least involved and Type 4 the most severe. Placement of the socket is perhaps the most important part of total hip replacement for patients with hip dysplasia. The best results are usually obtained when the socket is placed as close as possible to the normal anatomical location. Pre-operative planning is especially important because dysplastic hips may be at a higher location than normal and need special techniques to be brought down to the normal level. Additional considerations are whether to use cement to hold the artificial parts in place, or whether to use special methods that allow bone to grow into the artificial parts without cement. This is important in hip dysplasia because patients tend to be younger than patients with other types of arthritis.


NEW TECHNIQUE FOR HIP DYSPLASIA: Michael K. Ryan, MD, an orthopedic surgeon at The Hip Center at Andrews Sports Medicine in Birmingham, is one of only a few hip preservation surgeons who surgically treats these hip abnormalities with a surgical technique called periacetabular osteotomy (PAO). The PAO is the main surgery used to correct acetabular dysplasia in adolescents and adults with fused growth plates. The procedure takes about 3 to 4 hours and corrects the bony deformity which helps to relieve symptoms. It also helps normalize the load across the joint by re-orienting the hip socket in a more optimal and normal position. “The biggest initial surgical risk with PAO is bleeding, because we are cutting bone, and a tourniquet cannot be used during the surgery,” Ryan says. A successful PAO performed in patients diagnosed early enough can delay arthritis for 10 to 30 years or more following surgery, which could be the difference between a hip replacement at 35 versus 55 or older.


* For More Information, Contact:

Joel Williams, MD                                                                   Ann Pitcher, Pitcher Communications                                       

(312) 432-2496                                                                       (630) 234-4150


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