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Secondary osteoarthritis of hip — Clinical Guidelines

Overview

Secondary osteoarthritis of the hip often develops as a complication following developmental dysplasia of the hip (DDH), leading to chronic mechanical pain and joint degeneration despite initial corrective surgeries like periacetabular osteotomy (PAO). 1 3 14

Diagnosis

Clinical Examination: Assess for abnormal gait, pain, and range of motion limitations. 3

Radiographic Imaging: Utilize X-rays to evaluate joint space narrowing, osteophyte formation, and acetabular dysplasia. 16

Ultrasound and MRI: For detailed assessment of soft tissue abnormalities and joint morphology, particularly in early stages. 3

Management

Surgical Interventions:

- Periacetabular Osteotomy (PAO): For younger patients with preserved joint space and correctable deformities. 1 - Femoroacetabular Impingement (FAI) Correction: Considered in cases with proximal cam impingement due to dysplasia. 6

Medical Management:

- Vitamin D Supplementation: To reduce postoperative complications such as delayed union. 2 - Pain Management: Use of analgesics (e.g., NSAIDs) and multimodal pain strategies post-surgery. 11

Physical Therapy: Focus on strengthening hip abductors and improving joint stability. 3

Special Populations

Pediatrics: Early detection and intervention are crucial to prevent secondary osteoarthritis. 3 8

Elderly: Consider conservative management initially, with surgical options reserved for severe cases with functional impairment. 14

Comorbidities: Vitamin D status should be evaluated, especially in patients undergoing surgery, to mitigate complications. 2

Key Recommendations

Periacetabular Osteotomy (PAO) should be considered for younger patients with preserved joint space and correctable deformities to delay progression of secondary osteoarthritis (Evidence: Moderate 1).

Postoperative monitoring of vitamin D status is recommended to reduce the risk of complications following PAO (Evidence: Moderate 2).

Early diagnosis and intervention in pediatric patients with hip dysplasia are essential to prevent the development of secondary osteoarthritis (Evidence: Strong 3 8).

Femoroacetabular impingement correction may be beneficial in patients with proximal cam impingement secondary to hip dysplasia (Evidence: Expert opinion 6).

Multimodal pain management strategies should be employed post-surgery to optimize patient recovery and functional outcomes (Evidence: Moderate 11).

References

1 Ahmad SS, Giebel GM, Perka C, Meller S, Pumberger M, Hardt S et al.. Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2023. link 2 Kitade K, Mawatari T, Baba S, Sueda R, Hagio S, Kawahara S et al.. Vitamin D status-associated postoperative complications in patients with hip dysplasia after periacetabular osteotomy: A case-control study. Modern rheumatology 2023. link 3 Young JR, Anderson MJ, O'Connor CM, Kazley JM, Mantica AL, Dutt V. Team Approach: Developmental Dysplasia of the Hip. JBJS reviews 2020. link 4 Ângelo ACLPG, de Campos Azevedo CI. Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2019. link 5 Faucett SC. Editorial Commentary: Hip Arthroscopy in Hip Dysplasia: Just Because You Are Doing It, Should You?. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2018. link 6 Wetzler MJ. Editorial Commentary: No 2 Hips Are the Same-Femoroacetabular Impingement May Be More Proximal in Patients With Developmental Dysplasia. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2017. link 7 Aarnes TK, Hubbell JA, Hildreth BE. Use of sedation and ropivacaine-morphine epidural for femoral head and neck ostectomy in a dog. The Journal of small animal practice 2014. link 8 Heywood NA, Paton RW. Beware the syndrome in neonatal hip instability: follow up assessment is required after apparent resolution. Acta orthopaedica Belgica 2012. link 9 Vezzoni A, Boiocchi S, Vezzoni L, Vanelli AB, Bronzo V. Double pelvic osteotomy for the treatment of hip dysplasia in young dogs. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2010. link 10 Malm S, Strandberg E, Danell B, Audell L, Swenson L, Hedhammar A. Impact of sedation method on the diagnosis of hip and elbow dysplasia in Swedish dogs. Preventive veterinary medicine 2007. link 11 Jaeger GT, Larsen S, Søli N, Moe L. Two years follow-up study of the pain-relieving effect of gold bead implantation in dogs with hip-joint arthritis. Acta veterinaria Scandinavica 2007. link 12 Bialik V. Arnold Pavlik (1902-62): an autobiography. Journal of medical biography 2006. link 13 Leppänen MK, McKusick BC, Granholm MM, Westerholm FC, Tulamo R, Short CE. Clinical efficacy and safety of dexmedetomidine and buprenorphine, butorphanol or diazepam for canine hip radiography. The Journal of small animal practice 2006. link 14 Langlais F, Lambotte JC, Lannou R, Gédouin JE, Belot N, Thomazeau H et al.. Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction. Joint bone spine 2006. link 15 Poma PA. Bilateral hip dysplasia. A case report. The Journal of reproductive medicine 1998. link 16 Madsen JS, Svalastoga E. Inclination and anteversion of collum femoris in hip dysplasia and coxarthritis. Acta veterinaria Scandinavica 1994. link 17 Ley CC, Villar RN, Ronen A. Splinting for CDH: temporary splinting for the neonate. Prosthetics and orthotics international 1990. link 18 Leitz G, Reck R. Necessarily disappointing results after tripleosteotomy in the dysplastic hip joint. Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie 1979. link

Secondary osteoarthritis of hip