What is the initial management approach for patients with anterior hip dysplasia?

From the Guidelines

The initial management approach for patients with anterior hip dysplasia should prioritize conservative, non-surgical measures, including activity modification, physical therapy, and pharmacologic interventions such as non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injections, as recommended by recent guidelines 1.

Key Components of Initial Management

• Activity modification to avoid positions that exacerbate symptoms, particularly those involving hip extension, external rotation, and abduction
• Physical therapy focusing on strengthening the hip flexors, internal rotators, and adductors to improve stability of the anteriorly deficient acetabulum
• Pharmacologic interventions, such as:
  • NSAIDs (e.g., ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) for pain management as needed 1
  • Intra-articular corticosteroid injections for temporary relief in patients with significant inflammation 1
• Weight management, as excess weight increases stress on the hip joint
• Assistive devices like canes or crutches to reduce weight-bearing during symptomatic periods

Rationale for Conservative Approach

The conservative approach is justified because many patients with mild to moderate anterior dysplasia can achieve symptom control without surgery, and these interventions address the biomechanical instability and resulting inflammation that cause pain 1. If conservative management fails after 3-6 months, surgical options, including periacetabular osteotomy, may need to be considered, particularly in young adults with symptomatic hip OA and dysplasia 1.

From the Research

Initial Management Approach for Anterior Hip Dysplasia

The initial management approach for patients with anterior hip dysplasia involves a comprehensive evaluation of the patient's condition, including the severity of the dysplasia and the presence of any associated symptoms or conditions.

• The diagnosis of hip dysplasia can be made by measuring a CE angle < 25° on a plain standing radiograph of the pelvis 2.
• For patients with significant symptoms and dysplastic or retroverted acetabulum, periacetabular osteotomy (PAO) is recommended 2.
• Femoroacetabular impingement (FAI) with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery 2.
• Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears, but it may not be sufficient for patients with significant hip dysplasia 2, 3, 4.
• In cases where hip arthroscopy is performed, it is recommended to do so concurrently with or after PAO, rather than before, to avoid rapid progression to degenerative joint disease 3, 4.
• For patients with mild hip dysplasia, hip arthroscopy with labral repair may be beneficial, but it is essential to carefully evaluate the patient's condition and consider the potential risks and benefits of the procedure 3, 4.
• In general, the treatment of hip dysplasia should be individualized and tailored to the severity of the disease, and may involve a combination of non-pharmacologic modalities, drug therapy, and surgical interventions 5.