What is Triple Pelvic Osteotomy?
Triple Pelvic Osteotomy (TPO) is an operation used to correct a shallow or abnormally directed hip socket, a condition known as acetabular dysplasia. TPO is sometimes also used for the treatment of other conditions which predispose to developing osteoarthritis of the hip joint. The 'Interlocking' TPO which I perform was designed and developed by Mr John O'Hara, an Orthopaedic Surgeon who practices in Birmingham, England.
What is acetabular dysplasia?
Acetabular dysplasia is a shallow and abnormally directed hip socket (see Figure 1). The condition is most commonly associated with a subtle abnormality of the hip joint at birth (congenital hip dislocation) and often remains undetected for many years. Sometimes acetabular dysplasia can develop as the result of other childhood hip conditions such as infection, trauma or Perthes disease.
What are the consequences of acetabular dysplasia?
Hip joints which are abnormally shallow are predisposed to progressive damage to the cartilage, leading to osteoarthritis. Acetabular dysplasia is one of the leading causes for the development of hip joint osteoarthritis in women.
I've never had a painful hip before, why now?
The hip does not become painful until enough damage has accumulated in the joint. The first symptoms are often mild groin discomfort. Once the joint becomes painful, gradual deterioration of the hip joint can reliably be predicted; however reducing your activity level may reduce the symptoms.
How long will my hip joint last?
This is sometimes a difficult question to answer. Once the hip becomes painful, acetabular dysplasia predictably causes progressive damage to the joint, but the progression can be very slow. Most patients experience ongoing discomfort which gradually worsens over many years, even decades. Patients with very shallow hip joint sockets who have developed symptoms around the age of 20 rarely get beyond their early thirties without requiring an artificial joint replacement.
Why not just wait until I develop severe arthritis, then get an artificial joint replacement?
This is certainly an option to consider. In suitable patients however, Triple Pelvic Osteotomy can reliably improve the symptoms which you are currently experiencing. In addition, although artificial joint replacements such as resurfacing or total hip replacement are highly successful, joint replacements do not last as long in younger patients. Once the joint surfaces have been removed to perform an artificial joint replacement, they can never be returned. As younger patients have longer to live, the chances of requiring increasingly complex re-operations to revise failed artificial joint replacements over your lifespan is higher. Triple pelvic osteotomy preserves the joint surfaces and is a much better alternative in the long-term as the procedure offers a very good chance of buying a significant amount of time before artificial joint replacement is, if ever, required.
How can a Triple Pelvic Osteotomy help?
Patients managed with TPO reliably experience an improvement in their symptoms, due to a reduction in the amount of load placed on the damaged cartilage. By correcting the abnormality which causes progressive damage to the hip joint, TPO prevents or slows the progression of osteoarthritis. Should joint replacement be required in the future, the improvement in socket shape and orientation created by TPO can make the subsequent joint replacement a less complex procedure. Many patients with acetabular dysplasia have a short leg, which TPO will also partly correct.
What does a Triple Pelvic Osteotomy involve?
TPO is performed through two incisions, one in the buttock region and one around the lower bikini line. The pelvic bone is cut in three places, and the hip socket is rotated into correct alignment. A metal plate and screws are placed to hold the hip socket in the corrected position until the bone re-unites (see Figures 1 & 2).
Figure 1: Severe acetabular dysplasia
Figure 2: After treatment by Interlocking TPO
What are the limitations of Triple Pelvic Osteotomy?
The best results with TPO are seen in younger patients with early hip disease who have developed symptoms relatively recently. Patients who have well established arthritis are usually better managed with either a hip resurfacing or a total hip replacement.
Are any other operations required?
Hip arthroscopy (key hole surgery) may be recommended to treat any damage within the hip joint which has already occurred or to assess the suitability of the hip joint for the TPO procedure. Approximately 9-12 months after the TPO, a smaller procedure will be required to remove the metal screws and plate, which can be performed as a day case. Removal of the metalwork is usually recommended - this is conducted using the upper portion of the bikini-line incision previously made to perform the TPO procedure.
Will TPO be recommended to patients who smoke cigarettes?
Generally not. Poor bone healing after TPO is generally uncommon, but much more likely in smokers. Smokers are advised to seek professional advice from their General Practitioner to quit smoking before the TPO operation is recommended.
How long will it take to recover?
You will require the use of two crutches for 6 weeks. During this time, you can place only a small amount of your body weight onto the operated hip ('touch weight bearing'). You will then require one crutch for a further 6 weeks, but progressive weight bearing is allowed as comfort allows. You can drive a car and return to work 6 weeks after surgery.
Is physiotherapy required after the TPO?
Regular physiotherapy is essential during the recovery period to assist in rapid recovery of joint function and muscular control.
What are the risks?
TPO is a safe operation. The risk of infection is small (<1%). Patients commonly experience a numb patch below the groin incision, which often recovers but may be permanent. Serious nerve injury is very rare. Delayed bone healing requiring treatment is seen in less than 5% of cases, the risk is highest in patients who smoke cigarettes. Approximately 10% of patients will require an artificial joint replacement 10-15 years after a triple pelvic osteotomy.
This information handout has been written by Dr Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment.