Young active patients (15 to 40 years of age) who complain of non-specific worsening hip pain can present a challenge for clinical assessment: routine imaging and examination may be inconclusive with no evidence of instability or arthritis. According to Henry Boateng, M.D., orthopaedic trauma surgeon, Bone and Joint Institute, “This presentation can be a result of femoroacetabular impingement, hip dysplasia or a combination of the two. If treated early, before significant damage to articular cartilage occurs, it’s possible to relieve pain and prevent articular damage.” Dr. Boateng further describes, “Ganz periacetabular osteotomy (PAO) is an effective treatment for hip dysplasia in young adults; impingement symptoms are typically treated by decompression either with hip arthroscopy or open surgical dislocation. Though the two are very similar, it is important to distinguish between them and apply the correct treatment.”
Accurate diagnosis requires a comprehensive work-up, including visualization of cartilage by magnetic resonance arthrogram, as well as CT scan to evaluate the hip morphology. Dr. Boateng notes, “Even mild dysplasia can result in significant dynamic hip pain and affect otherwise active people. The goal is to improve pain, restore function and ‘preserve’ the hip. By contrast, impingement symptoms offer a similar pain pattern, but with subtle differences (for example, impingement is usually a static symptom as opposed to dynamic symptoms). A labral tear is most often present on MRI; although it should be addressed, it is usually a symptom of either dysplasia or impingement. We tailor the treatment to the patient and decide on an arthroscopic procedure, open procedure or sometimes both depending on the type, size and location of the lesion.”
Dr. Boateng highlights a recent case in a 35-year-old patient who reported significant dynamic and stationary hip pain with a worsening tolerance to sit and drive for two years. After a work-up and review of images, the patient was diagnosed with marked symptomatic impingement. For these cases, Dr. Boateng has used the lateral Gibson approach described by Ganz, et al.,¹ after spending time with Ira Zaltz, M.D., an expert in PAO and surgical dislocations.² Dr. Boateng adds, “My experience with this technique has been very positive. It specifically preserves the vascular supply to the joint and none of my cases have experienced femoral avascular necrosis, which has been recognized as a potential complication of hip dislocation.” At the six-month follow-up, this patient was pain-free, improved her activity level and is back to work. According to Dr. Boateng, “Most patients who undergo this procedure experience significant pain relief, and after physical therapy and rehabilitation, improve their quality-of-life. This particular patient was frustrated with worsening hip pain, no clear etiology and no improvement with conservative treatment. She felt her only option was arthroplasty. Fortunately, the right diagnosis yielded an available treatment option.”
Young adult patients with symptomatic hip dysplasia or impingement are often treated conservatively, until they reach an age where hip arthroplasty is considered appropriate. The availability of atraumatic surgical dislocation and periacetabular osteotomies, in conjunction with a tailored progressive treatment plan, provides more options to young adults with hip pain.
Henry Boateng, M.D.
Assistant Professor, Orthopaedics and Rehabilitation
Orthopaedic Trauma Surgeon
FELLOWSHIP: Orthopaedic trauma, Brigham and Women’s Hospital, Boston, Mass.
RESIDENCY: Orthopaedic surgery, Johns Hopkins Hospital, Baltimore, Md.
MEDICAL SCHOOL: Georgetown University School of Medicine, Washington