It is not unusual to be asked if a labral tear needs to be repaired when this is found in association with dysplasia and a PAO is being planned. The development of pain in hips with dysplasia is usually as a result of an injury to the labrum. The labrum is a soft cartilaginous tissue that attaches around the edge of the hip socket (the acetabulum) and provides a suction seal for the joint. It has lots of nerve endings in it which means that when it is injured pain is experienced. The injury that usually occurs to the labrum can happen in a number of ways, but the most common injury is a separa ..read more

Some hip preservation techniques are associated with a relatively long recovery. In particular the periacetabular osteotomy (PAO) used to re-orientate the acetabulum to treat hip dysplasia, does require quite a long period on crutches afterwards while the bone heals. Even hip arthroscopy can take several months to recover from and get back to sports and exercise. So why not just have a hip replacement? This is a question often asked. Recovery after hip replacement is relatively quick nowadays. Mostly weight bearing is not restricted afterwards and by 6 weeks most people are off crutches doing ..read more

Having recently undergone surgery to my shoulder for a rotator cuff tear, I have been able to reflect on the major differences  there are with bone healing compared to soft tissue to bone healing. In hip replacement surgery we often use implants with a special coating on that allows bone to bond directly to the metal of the implant (so-called uncemented hip replacement). Once this bond has occurred, it is incredibly strong and is part of the reason implants can function for such a long time without becoming loose. That process of bonding takes 6 weeks to occur and during that time it is i ..read more

Thoughts are changing rapidly around surgery and recovery after hip replacement surgery. I think it is important that for the most part, those that need a hip replacement should not consider themselves as “patients” or that they are “sick” as is usually the association with being in hospital. Rather, I think the thought process should be around something being damaged that needs to be fixed. With the introduction of less invasive methods for total hip replacement surgery, such as the Direct Anterior Approach, combined with anaesthetic techniques that allow a more rapid recovery after anaesthes ..read more

It definitely feels like something of a landmark now having performed over 1000 PAOs. It is interesting to reflect on the progress in surgical technique as well as the understanding of hip dysplasia. The operation itself, originally developed by Professor Reinhold Ganz in Bern Switzerland, represented a major step forwards in terms of a technique to re-orientate the acetabulum and address hip dysplasia and some other abnormalities of acetabular orientation. Every time I perform the operation I find it extraordinary that it was possible to work out how to free the acetabulum from the rest of th ..read more

This remains a difficult question to answer and depends on a number of individual circumstances. Increasingly the Orthopaedic community is gathering more and more information from registries from  around the world  that tell us how certain implants are doing. There can be conflicting information because different countries have a slant towards different implants and it is difficult to rule out the effect of historical bias where certain implants may not have been successful and are no longer used. Broadly hip replacements can be divided into those which are cemented and those that are uncement ..read more

Decision making with regards to hip dysplasia can at times be very difficult. One of the areas that is often not straightforward is in patients who are perhaps a bit older than the norm for this procedure (over the age of 40) and appear to have a good joint on X-ray. In general terms a hip is not suitable for a PAO if there is too much in the way of wear and tear arthritis in the joint. In these circumstances the best way to improve pain and function is to have a hip replacement. Sometimes one has to accept that it is not possible to preserve the native hip joint even when a patient is young a ..read more

At the recent meeting of the International Society for Hip Arthroscopy and Hip Preservation, in Melbourne Australia, there was a lot of interest in the idea of a less invasive way of performing a PAO. The original description of the PAO was for it to be performed through a rather large surgical approach and the scar that resulted did not heal in a very cosmetic fashion. We published our outcomes using a minimally invasive technique last year (Bone and Joint Journal 2017;99-B:22–8 ) and this related to a technique that we developed and have used since 2010. I was asked to give a number of prese ..read more

The Direct Anterior Approach (DAA) to perform hip replacement surgery is a minimally invasive approach with less in the way of muscle splitting or muscle cutting than other approaches to the hip. At every hip meeting I have been to in the past year there continues to be a lot of debate as to what the advantage is and whether there are longterm gains to be had. There certainly are those who oppose the idea of this being a good approach and this relates to data that is presented in relation to the ‘learning curve’ to safely perform the approach. The learning curve is the number of procedures a s ..read more

A recent study has concluded that surgical management of FAI gives improved outcomes over a conservative programme with physiotherapy. This is an important study because it was a randomised controlled trial which means that patients who agreed to be part of the study were randomly allocated to treatment with either surgery or physiotherapy. These patients were recruited from a number of different centres. This type of study is the most valid in terms of a scientific investigation. After a follow-up of one year patients were re-evaluated to assess their outcomes and the patients who had undergo ..read more