Therapy | Hip dysplasia in adults

Therapy

Depending on age and physical findings, various surgical therapy options are available. For about 30 years, the triple pelvic osteotomy according to Tönnis has been considered a proven method for the treatment of hip dysplasia in adults. The hip socket is surgically removed from the pelvic compound and brought into a normal canopy position.

Another possibility is the so-called intertrochanteric derotation-varisation osteotomy of the femur. In children, the Salter osteotomy of the pelvic bone is the method of choice. Many patients receive an artificial hip in early adulthood, if the arthrotic changes are too advanced.

All interventions on the hip joint are complicated. Especially the operations on the pelvic bone are technically not easy and should therefore only be performed by specialized and experienced surgeons. Physiotherapeutic exercises with a combination of massage, stretching and stabilization exercises are a targeted therapy to improve the symptoms of hip dysplasia and to delay joint wear and possibly necessary surgery.

The massage serves to release muscle tension. The loosened muscles can thus provide better stability and prevent premature joint wear. Stretching the muscles ensures that muscles that have been shortened due to incorrect loading or relieving posture are stretched again.

In addition, exercises that strengthen the hip muscles should be performed. These are also taught by the physiotherapist. Patients should perform these exercises regularly at home.

Such exercises should serve to maintain mobility in the hip. The exercises performed in cases of hip dysplasia should therefore always include the movements abduction (spreading the leg to the side), extension (spreading the leg backwards) and flexion (hip flexion). If possible, a rotation exercise should also always be included.

Above all, if pain occurs, the exercises should be stopped immediately.

  • A possible exercise is the hip lifting or also pelvic lifting. Here the patient lies on his back and puts his legs up so that the knees are bent, the arms are laid down beside the body.Now the pelvis is raised until the upper body and thighs form a line.

    Exhale when lifting the pelvis. Then the pelvis is lowered again and breathed in. This exercise is repeated at least 10 times and after a break at least a second set should follow.

  • The straddle is particularly suitable for training the abductors (muscle group on the legs that lift the leg to the side) and for promoting the abduction movement of the hip.

    The patient lies on his back again. The arms are again laid down next to the body, the legs are stretched this time. Now first one leg, for example the left one, is spread as far as possible to the side and then brought back to the middle.

    Then the right leg is spread out as far as possible. This exercise is performed about 10 times on each side.

  • To train flexion, the patient can perform another exercise in the supine position. In the starting position the legs are stretched and the arms are laid down next to the body.

    Now one of the legs is angled and pulled towards the chest with the help of the hands, as if the thigh were to be placed on the chest. The other leg remains stretched out on the floor. This stretching position is maintained for a few seconds.

    Then the leg is put down again and the other leg is lifted and stretched. Also for this exercise, at least 10 repetitions on each side are recommended.

If conservative measures show no improvement in the symptoms of hip dysplasia, or if hip dysplasia is detected too late or is too pronounced, the femoral head can be brought back into the acetabulum by means of surgery. In most cases, the femoral head is removed from the acetabulum and the acetabulum is then brought into a better position so that the femoral head is once again better positioned in the acetabulum.

If the hip dysplasia is accompanied by arthrosis, where all conservative measures could not relieve the symptoms, a hip joint replacement by means of an endoprosthesis is necessary. Whether the complete joint is replaced by an artificial hip or only parts of it depends on the degree of joint destruction. For example, if the acetabulum is undamaged, it would be possible to preserve it and replace only the head of the femur (duo-head prosthesis). If both parts – i.e. the acetabulum and the head of the femur – are damaged, a complete hip joint replacement is performed by means of a prosthesis of the head of the femur and the acetabulum (total hip endoprosthesis).