Choosing a treatment for hip dysplasia in 2024

Background: The management of developmental dysplasia of the hip (DDH) in adolescents and adults has evolved significantly, with a shift towards acetabular reorientation and arthroscopic techniques. However, selecting the optimal treatment from a wide array of non-surgical and surgical options remains a clinical challenge, necessitating clear guidance for surgeons on procedural indications.

Objective of the Article: This article provides a comprehensive overview of the diagnostic workup and therapeutic options for DDH, aiming to establish a clear framework for treatment selection based on clinical presentation, specific radiographic parameters, and the degree of osteoarthritis.

Key Points / Core Message: A precise diagnosis is foundational, requiring a thorough clinical examination and standardized radiographic evaluation, including AP pelvis, false profile, and Dunn views to measure key angles (VCE, VCA). Advanced imaging, such as arthro-CT, is indispensable for surgical planning. Treatment options range from non-operative management to complex hip-preserving surgery. Hip arthroscopy is reserved for borderline dysplasia (VCE 18-25°) and requires meticulous capsular and labral management. Periacetabular osteotomy (PAO) is the gold standard for congruent, non-osteoarthritic hips. For non-congruent joints, severe dysplasia, or early osteoarthritis, salvage procedures like the Chiari osteotomy or, in select cases, bone block arthroplasty are indicated. Femoral osteotomies address associated deformities.

Conclusion / Implications for Practice: The treatment of DDH must be tailored to the individual patient. Acetabular reorientation via PAO offers the best outcomes for well-selected cases without significant osteoarthritis. In cases of incongruence or advanced dysplasia, salvage osteotomies like the Chiari are preferred. Total hip arthroplasty remains the solution for hips with advanced osteoarthritis (Tönnis grade 2-3).