Younger Adults with Hip Problems

Hip Dysplasia

Hip Dysplasia is a developmental condition where the acetabulum does not fully cover the femoral head leading to increased pressure within the joint which may cause pain and predispose to early onset osteoarthritis.
Those who have severe pain and limp without significant osteoarthritis may be considered for surgery to realign the acetabulum (Periacetabular Osteotomy) which is major surgery with 3 months off work and up to a year recovery time.
Where moderate changes of osteoarthritis on x-ray are present, Periacetabular Osteotomy will not be considered.

Hip Impingement (Femoroacetabular Impingement or FAI) occurs when there is abnormal contact between the edge of the acetabulum and the femoral neck resulting in pain. Various theories exist regarding its aetiology and it is likely a combination of activity (repeated hyperflexion and adduction) and genetic influences.
Repeated contact may cause tearing of the acetabular labrum and delamination of the acetabular hyaline cartilage. Morphologic changes associated with impingement include acetabular overcoverage (retroversion, pincer deformity) and a bump on the femoral neck (cam lesion).
In younger adults with hip impingement without dysplasia who have not improved with physiotherapy, arthroscopic surgery to remove any impinging bone and to reattach or remove damaged labrum may be considered. This surgery is, however, controversial with inconsistent outcomes.
Where there are x-ray changes of moderate or more severe arthritis, hip arthroscopy for impingement will not be considered.

The management of pain from suspected labral tears without evidence of dysplasia nor bony features of FAI is highly controversial. Many asymptomatic people have labral tears without any clinical problem. Hip arthroscopy for labral tears alone may not solve a problem. Patients should not be informed that their pain is due to or likely caused by a labral tear without specialist review.
Again, where moderate or more severe changes of arthritis are present on x-rays, hip arthroscopy will not be considered.

In younger adults with established osteoarthritis, only those with severe enough OA changes on x-rays and severe enough symptoms will be considered for Total Hip Replacement as there are long-term implications to having a joint replacement at a young age.