Hip Preservation Options to Treat Hip Dysplasia


By Arthur Manoli III, MD, hip preservation and joint replacement surgeon at ONS

Hip dysplasia occurs when the hip socket doesn’t fully support the ball of the joint. It is very common yet some people are asymptomatic. Often hip dysplasia develops during childhood, yet symptoms may not crop up until well into adulthood.

Many people who have hip dysplasia are hypermobile; they might be great at gymnastics or just incredibly flexible. If their muscles are strong, they may not experience any symptoms of their underlying dysplasia. We’ve found that with time, certain triggers may increase the risk that they hurt their hip. For example, dancers may experience a torn labrum or women may get hip pain after childbirth. While these injuries may seem small, because it’s caused by underlying dysplasia, patients can’t easily rid themselves of the pain which may continue to progress over time.

When left untreated, hip dysplasia can lead to osteoarthritis.

There are numerous treatment options available for hip dysplasia ranging from conservative to surgical. We always start with nonsurgical treatment, which is a special interest of mine. During an initial evaluation, I perform a detailed assessment of muscle strength and inflammation. While we can’t fix the underlying dysplasia without surgery, we can help strengthen specific muscles to help hips function better, which may alleviate symptoms. I provide physical therapists with detailed, patient-specific treatment plans that focus on improving muscle strength and coordination. In some circumstances, we can offer injections to decrease inflammation so patients can more effectively strengthen their muscles.

Oftentimes, due to the complex nature of the hip, the source of a patient’s pain may be unclear. In these cases, I like to perform diagnostic ultrasound-guided injections and then reexamine patients shortly thereafter. This can usually be done on an initial visit and can help confirm that a patient’s symptoms are related to a significant problem in the hip joint.

From a surgical perspective, there are a variety of procedures that are appropriate depending on the patient’s age, amount of dysplasia and their activity level. In cases of mild hip dysplasia with a labral tear, some patients may be candidates for hip arthroscopy, which is a minimally-invasive method to reshape part of the bone and fix the labral tear.

Another surgical option is a periacetabular osteotomy (PAO), in which we try to save the patient’s natural hip by increasing the coverage of the hip pocket. When we perform a PAO, we almost always combine it with a hip arthroscopy so that we can fix everything wrong with the hip in one surgery. This is the best way to protect against the need for revision surgeries and it offers peace of mind. The issue is rarely just a shallow socket – there can also be a twisted bone, labral, tendon or cartilage tear, or other potential issues. We like to address all potential pain generators at the same time to give patients the best chance of achieving a great, long-lasting result.

The benefit of a hip preservation procedure such as a PAO is that you keep your own hip – your natural hip is the best hip you will ever have. It will function the best and last the longest. Whenever there is a chance that we can save the hip, that’s what we prefer to do. We have seen many successful hip preservation surgeries lead to higher activity levels for patients with significantly less pain.

Young patients do particularly well with hip preservation surgery – after a period of partial weight bearing and physical therapy, patients may get back to full activities as soon as 4-6 months after surgery.

For older patients with dysplasia, the best treatment may be a hip replacement surgery. During your evaluation, we discuss your preferences and desires and use a shared decision-making approach to help identify the best treatment for you. Since I perform both hip preservation and replacement surgeries, I have a special interest in guiding patients through difficult treatment decisions.

Currently, I am one of the only surgeons in the state of Connecticut who is performing PAO procedures for hip dysplasia and one of only a handful in the U.S. who do it combined with hip arthroscopy during one operation. Hip preservation is a unique field within orthopedics – our understanding of the hip has really taken shape over the past decade. If you are experiencing hip pain, it is best to see a specialist who has advanced training in complex hip problems. Specialists trained in both hip preservation and joint replacement procedures offer added benefits to patients in that we can accurately diagnose the root cause and determine the best plan of action—whether it’s saving your hip or replacing it.

About Dr. Arthur Manoli III

Dr. Manoli is a hip preservation and joint replacement surgeon at Orthopaedic & Neurosurgery Specialists (ONS) specializing in open and arthroscopic hip preservation surgery as well as hip and knee replacement surgery. He is one of the few surgeons in the country with advanced training in both hip arthroscopy and periacetabular osteotomy procedures for hip dysplasia in young adults. To schedule an appointment, please call our offices at (203) 869-1145.