Hip dysplasia (also known at Developmental Dysplasia of the Hip – DDH) describes the condition when the hip socket does not develop properly and is more shallow and upward sloping than normal. The severe forms are detected and treated at birth or infancy but milder forms may not become apparent until adolescence or early adult life. The shallow socket leads to excessive forces on the front of the hip socket causing tears of the acetabular labrum and damage to the articular cartilage. Left untreated, this cartilage damage progresses to osteoarthritis, sometimes within only a few years. Early diagnosis is therefore important to improve the mechanics of the hip and relieve symptoms.
The condition is much more common in females and presents symptoms of a hip injury. Reduced walking distance and stamina develops relatively early as the muscles become more easily fatigued as they try and stabilise the hip. Instability and feelings of giving way in the hip are therefore another feature of hip dysplasia.
The most effective treatment for significant and progressive symptoms is an operation to rotate the hip socket round so it becomes more horizontal (peri-acetabular osteotomy - PAO). Whilst surgery to re-orientate shallow hip sockets has been around since the 1960s, it was not until the late 1980s that a safe reproducible method of performing the surgery was developed by Professor Reinhold Ganz in Berne, Switzerland. It is for this reason that the PAO is also known as a Bernese osteotomy or Ganz procedure. The PAO has been further modified with a minimally invasive method of performing the surgery being developed by Professor Kjeld Søballe from Aarhus in Denmark in 2003. Mr Bankes visited Prof Søballe in 2010 and now uses his technique.
These advances have turned pelvic osteotomy from a lengthy operation requiring blood transfusion and at least 10 days in hospital and three months on crutches to a procedure that takes under 90 minutes, has a hospital stay of two to four days with only six weeks on crutches. A PAO is a real opportunity to improve the hip mechanics and restore these young people's active lives without resort to implants and postpone the development of arthritis by decades. The success rate of PAOs is at least 90% in relieving pain when performed before arthritis has developed with slightly less predictable results in the presence of arthritis and in patients over 45.