Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options.

Hip dysplasia is a developmental disorder that results in anatomic abnormalities leading to increased contact pressure in the joint and, eventually, coxarthrosis. However, many patients with hip dysplasia become symptomatic before the development of severe degenerative changes because of abnormal hip biomechanics, mild hip instability, impingement, or associated labral pathology. Several nonarthroplasty treatment options are available. Because the primary deformity is mostly acetabular, for many patients, a reconstructive osteotomy that restores more nearly normal pelvic anatomy is preferable. The Bernese periacetabular osteotomy is presently favored because it provides good correction while creating little secondary pelvic deformity or destabilizing the pelvis. Proximal femoral osteotomy is occasionally needed as a complement to pelvic osteotomy and may also be indicated as an isolated procedure when most deformity is located on the femoral side (coxa valga subluxans). Arthroscopy can be beneficial when symptoms seem to be related only to labral tears or loose bodies in the absence of severe structural abnormalities about the hip. Fusion and resection arthroplasty are rarely indicated and are reserved for occasional patients who are not candidates for total hip replacement or other procedures but who complain of refractory hip pain.