Hip Osteotomy

Learn everything about your treatment

  • Overview

    What Is Hip Osteotomy Surgery?

    Hip osteotomy is a surgery that realigns the bones of the hip joint to allow easier and pain-free movement. It can be used to treat symptoms of osteoarthritis and a range of other hip joint issues as well as prevent or delay the need for a hip replacement.

    What Can Hip Osteotomy Surgery Achieve?

    An osteotomy is a surgical procedure that alters misaligned bones and secures them into a better position. Common adjustments include trimming bones to change their shape or length or adjusting their alignment to remove pressure from damaged areas of the joint. The ‘ball and socket’ bones of the pelvis are involved: the femur (thigh bone) and acetabulum (the socket where the femur meets the pelvis).

    A hip osteotomy may also be referred to as ‘hip preservation surgery.’ It can treat or delay the progression of a range of conditions including:

    • Osteoarthritis
    • Hip replacement surgery
    • Hip dysplasia in younger adults

    A hip osteotomy aims to help prevent osteoarthritis development by adjusting the bones so they cause less stress and damage within the joint. It also aims to improve the range of motion and reduce pain.

    Who Are BOA?

    The British Orthopaedic Association, or BOA, is the leading UK orthopaedic organisation. BOA member surgeons attend regular training sessions to maintain their knowledge of the latest orthopaedic techniques and treatments. This ongoing investment in training means BOA member surgeons are some of the most highly qualified orthopaedic surgeons in the UK. Medbelle strives to only work with BOA member surgeons to ensure we provide every patient with the very best possible care.

  • Procedure

    How Is Hip Arthroscopy Performed?

    A hip osteotomy may be performed under a general anaesthetic, which is when you are given medication to help you sleep, or under a spinal anaesthetic with sedation. For the latter, numbing medication will be used on your spine so you don’t feel anything and you will be given another medication to help you feel relaxed. The type of anaesthetic you have will depend on the operation you are having, and will be a thoughtful decision between you and your surgeon. In general, the operation will take between 1.5 to 2 hours.

    Below is an overview of hip osteotomy surgery.

    Signing the Consent Form

    You will need to give your consent for the operation in the form of writing. You will do this before the surgery. This ensures that you have had enough time to obtain information about the hip replacement procedure, including the benefits and risks involved. Before you sign the consent form, you should also make sure that you have asked your surgeon any questions you have regarding the surgery.

    Anaesthesia

    On the day of your operation, you will first meet your anaesthetist. An anaesthetist is a doctor who administers medication to block feelings of pain or sensations or to help you into a state of sleep during your surgery. Anaesthetists specialise in keeping patients safe before and after the operation and while they are asleep. They will talk to you about having the anaesthetic and what you can expect.

    Incisions

    Once the anaesthetic is working, you will be taken to the operating room. The surgical team will position you comfortably and so your hip can be easily accessed. Your hip will be cleaned, then an incision (cut) will be made around the pelvic bone and small cuts will be made into the acetabulum to release a section of bone. This section of bone is then moved to a new position to ensure the acetabulum covers the head of the femur more evenly.

    There are several methods to align the hip joint. These include:

    Femoral Osteotomy

    This type of hip osteotomy focuses on abnormalities ball of the hip joint as they can result in several problems. These include damaged cartilage within the hip joint and tears to the labrum, which is the ring of cartilage surrounding the joint (known as 'hip impingement'). Hip impingement causes abnormal contact and friction within the joint, as well as the potential for further deformity and pain.

    Periacetabular Osteotomy

    This technique is most commonly used for hip dysplasia. This is a condition where the socket of the hip joint is too shallow to fit the ball of femur correctly. As a result, the ball of the femur puts more stress on certain points of the socket. This can eventually damage the lining of the socket which commonly leads to the early development of osteoarthritis.

    An x-ray will likely be used to check the placement of the altered bone. When your surgeon is pleased with the placement, the bone will be secured into its new location with screws.

    Closing the Incisions

    Once your surgeon is happy with the bone placement, the incisions are closed with stitches. Local anaesthetic may be administered to your hip area to prevent pain for a few hours after surgery.

    Recovery

    You will be transferred to the ward or recovery room where you will be monitored by your anaesthetist and other medical professionals as you wake up from surgery.

  • Candidates

    Who Is The Ideal Hip Osteotomy Candidate?

    In general, the ideal candidate for this procedure is under the age of 60 and lives an active lifestyle. As the newly positioned joint will need healthy cartilage and bone to support it, anyone with an unevenly damaged hip may not be suitable. The joint should also have little to no inflammation or deformation.

    Before the procedure, you should aim to be as fit and healthy as possible. This not only has a significant positive impact on recovery in the short term, but also the future health of your hip. There are a number of things you can do before surgery to help optimise your health:

    • If you are overweight, see your GP or specialist about losing weight in a sustainable and healthy way
    • Try to keep active as much as you can and consult your GP before you start a new exercise programme or change your activity levels
    • Stop smoking at least 6 weeks before and after your surgery because nicotine slows healing
    • Reduce your alcohol intake

    Who Is Not Suitable For Hip Osteotomy Surgery?

    People who are minimally active, older, and in poor health may not benefit from hip osteotomy. For cases of severe hip dysplasia or osteoarthritis, hip preserving methods like osteotomy may not be an effective choice and joint replacement may be a better treatment option.

  • Risks and Complications

    What Are The Main Hip Osteotomy Complications?

    Hip osteotomy is associated with potential risks and complications like any other surgical procedure. It is important you are aware of these risks and understand them before agreeing to have surgery. If you have any questions about any of the topics listed here, your surgeon will be happy to discuss them with you in more detail.

    The potential risks and complications of hip osteotomy include:

    General Surgical Risks

    Any surgery is associated with risks. Complications, such as postoperative nausea, vomiting and pain can occur, as well as the risk of a reaction to the drugs or anaesthetic. Your anaesthetist will monitor you closely during the procedure to help reduce the risks of these complications occurring.

    Osteoarthritis

    Although one of the main aims of a hip osteotomy is to prevent osteoarthritis, in some cases this procedure may contribute to its further development. Although altered to function as well as possible, the hip will still not as efficiently as a normal hip and therefore the stress and pressure on certain points may later lead to osteoarthritis. The extent of the original damage and shape of the bones before surgery may factor into the likelihood of further osteoarthritis development.

    Screw Displacement

    The screws used to secure the osteotomy may sometimes move and become more prominent. This leads to discomfort. Any screws that move position may need to be removed. However, this is more likely to be a day case, meaning you will be able to go home the same day as the treatment.

    Bleeding

    Bleeding is a potential risk during any surgery. There are several important blood vessels around the hip joint that can be damaged as the hip joint is operated on. You will be monitored closely for bleeding after the operation. If excess bleeding does occur, you may experience swelling and discomfort. In severe cases, further surgery may be necessary to resolve excess bleeding.

    Bruising

    You will likely experience some bruising around your hip after surgery. This is to be expected and can vary from person to person. Bruising will likely heal and disappear over time.

    Nerve Damage

    There are a number of important nerves near the hip joint. While rare, these can be damaged during surgery leading to lower leg weakness.

    Some numbness around the hip is also normal and should resolve naturally with time.

    Your surgeon will discuss these risks with you in greater detail before your surgery.

    Infection

    All operations are associated with a risk of infection, however, your surgeon and their team will use strict methods used to reduce this risk. In the unlikely event you develop an infection after surgery, you may show the following symptoms:

    • A temperature above 38° C
    • Increasing redness or swelling around the wound site in the first 2 days after surgery
    • Yellow, thick, or foul-smelling fluid coming from your incisions
    • Pain that is not relieved by painkillers

    If you believe you have an infection, seek urgent medical advice and contact your surgeon immediately.

    Osteotomy Failure

    In order for the osteotomy to be successful, the bones need to unite (heal together) but sometimes this doesn’t happen. Infection can increase the risk of failure. However, the strong natural blood supply to the hip reduces the chance of this happening. In the event the bones don’t heal together, further surgery may be required.

    Blood Clots

    Blood clots are a potential risk of any surgery and are slightly more common with orthopaedic procedures because of the very limited mobility after surgery. Blood clots can develop in the legs after long periods of inactivity. If these clots move to the lungs, it can be both dangerous and difficult to treat.

    Your surgeon will advise you on ways you can reduce your chance of developing a blood clot. This will include ways to keep mobile while recovering and the importance of wearing compression socks after surgery. Blood thinners may also be necessary to further prevent clots.

  • Preparing for Your Treatment

    How Can I Prepare For My Hip Osteotomy?

    Making preparations at home before the day of your hip osteotomy can ensure your recovery period is as calm and easy as possible. We have compiled a list of things to consider before your procedure to help you in preparing for your treatment.

    Some suggestions for your preparation:

    Driving

    Your surgeon may recommend that you avoid driving for at least 8 weeks. Your ability to drive will be based on your ability to bear your full weight on your hip, walk confidently, get in and out of the car, and perform an emergency stop. Your surgeon will advise you on when it is safe to return to driving. It is advisable that you discuss your surgery with your insurance company as any claims you make may be refused unless it is clear you were approved to be driving safely again. With this in mind, arranging support or alternative transport may be helpful before the procedure.

    Household Work

    Try to do any household work or chores before the day of your hip osteotomy. You might consider arranging the support of friends or family or even hire a cleaner to help clean during your recovery period. Doing housework or activities like this may be more difficult and likely against the advice of your surgeon during your rest and recovery period.

    Food Shopping

    It is important that you make sure your cupboards are well stocked before your hip osteotomy, particularly if you live alone or are responsible for the care of others. This is so you don’t have to worry about getting to and from the shops while you are unable to fully bear weight or drive.

    Many people find it helpful to prepare and freeze meals ahead of surgery so there’s no need to cook or rely on takeaway meals that tend to be high in sodium which can make swelling worse and prolong healing.

    Diet & Health

    A vital part of supporting your recovery is maintaining a healthy diet and lifestyle before and after your hip osteotomy.

    Aim to eat a balanced diet including plenty of lean protein, fresh fruits, and vegetables.

    Try to reduce your alcohol intake to a minimum during the post-operative recovery time. Your surgeon may recommend you do not drink alcohol at all during this time.

    Smoking & Nicotine Use

    It is very important that you stop any smoking or use of nicotine products entirely or do not smoke for 6 weeks before and after your hip osteotomy. This is crucial because nicotine reduces blood flow throughout the body. A lowered blood supply to a large surgical wound like one from hip osteotomy can put you at a much higher risk of developing dangerous complications like infection and overall drastically slow your recovery.

    Weight & BMI

    BMI (body mass index) measures your weight in relation to your height. It is roughly categorised into low, healthy and high. As well as having many health benefits, a healthy BMI and sustainable healthy weight can prevent additional pressure on your hip and other joints and help to promote a smooth recovery after hip osteotomy surgery.

    Your surgeon may recommend you lose a certain amount of weight before having a hip osteotomy. This is to help reduce the risks and complications associated with surgery, as well as improving the outcomes of the procedure and the long-term health of your hip.

    If you struggle to lose weight in time for the operation, your surgeon may be able to refer you to a specialist dietician or weight loss adviser for support.

  • Aftercare

    What Can I Expect After a Hip Osteotomy?

    After your hip osteotomy, you will likely have to stay in hospital for anywhere between 2 to 4 nights. You will be encouraged to try and stand the first day, often with the support and oversight of a physiotherapist. Providing all else is well, you likely be able to go home when you are able to move around independently.

    It is normal to be advised not to bear your full weight on your hip for several weeks after hip osteotomy surgery. To support you with mobility, you will be given a mobility aid such as crutches. As you rehabilitate, use of the walking aid will be reduced gradually.

    It will take approximately 6 weeks for your hip osteotomy to heal and the bruising to settle, but it is important to remember that recovery is ongoing after bruising fades. While many patients experience relief from hip pain quite quickly, it may also take the post-operative pain some time to settle down. Pain can also feel more intense after exercise. To help avoid this, it is important to take painkillers regularly. Specific advice regarding pain medication will be given by your surgeon.

    As well as physiotherapy, you will likely have a repeat x-ray arranged to see how the bones are healing. Many patients may limp when walking, especially while weaning off of using a mobility aid, but this very likely to improve with time.

    The First 24 Hours

    You will stay in hospital during this time and will be carefully monitored by medical staff. Most patients are encouraged to move out of bed the same day as their hip osteotomy with their physiotherapist. You will be given pain medication, most likely in the form of a pump called a PCA (Patient Controlled Analgesia). This allows you to give yourself painkillers by pressing a button.

    After Surgery

    If you were asleep during surgery with a general anaesthetic, you will gradually wake up following surgery under the close supervision of your anesthesiologist and other medical staff. You will have dressings around your hip and you may have some soreness in this area.

    The dressings may stay in place for up to a week before they are removed. If a spinal or epidural anaesthetic was used, you may feel a change in sensation in your hips and legs, but this will gradually wear off. Your hip may also feel tender, and moving around will be difficult. Your surgeon or the nurses in the recovery room will offer you painkillers which you can take if you need to. Some patients find they may wish to rent a wheelchair for several weeks to make going out easier or rest your hands which may become sore from using crutches.

    Time Away from Work

    The more physically demanding your job is, the more time you will likely be advised to take off. This can be up to 4 months for some patients. It may be ideal to take around 8 weeks if you are able. However, you may only need between 3 and four weeks if you work in an office or another low-impact environment.

    Returning to Exercise And Sport

    The recovery process varies from person to person, however generally the timeline for returning to activity can be longer for a hip osteotomy than other procedures, like hip resurfacing. For lower-impact activities like cycling, it may be possible to start at around 10 to 12 weeks post-surgery. For high-impact exercises like jogging or team sports, you will need to build to these very gradually after around 5 months though it may take even longer for some. While the return to your usual exercise routine is a focus, you may be advised to avoid certain activities in the future depending on the condition of your hip. Some impact sports may take at least 6 months to return to. The advice for returning to sexual activity varies, so make sure you ask your surgeon about this.

    Dressing & Stitches

    You will likely need to keep your wound covered initially. If your surgeon used staples or stitches to close your incision then the wound should be kept covered at least until the staples or sutures are removed.

    You will be able to shower or bathe normally once your surgeon advises that it is safe to do so. Your surgeon will also tell you when they will be able to remove your stitches. If you notice anything leaking from the wound, you should inform your surgeon straight away.

    Physiotherapy

    Physiotherapy programmes will be personally designed for you by your surgeon and physiotherapist. They may continue for several months after surgery. Some patients may also need hydrotherapy several times a week which involves special exercises that you do in a warm-water pool while supervised by a physiotherapist.

  • Final Results

    Results and recovery will vary from person to person. Generally, however, many people find relief from hip pain quite rapidly after surgery.

    Overall, many patients are able to resume the vast majority of their everyday tasks within 4 to 6 months after hip osteotomy. Full recovery may take up to 12 months for some.

  • Hip Osteotomy FAQs

    How long does hip osteotomy surgery take?

    On average, hip osteotomy surgery takes between 1.5 to 2 hours to complete.

    How long will I need to use a mobility aid after hip osteotomy surgery?

    This time varies from patient to patient, but for many people, it’s between 10 and 12 weeks.

    As you heal, you will need a mobility aid less and less. If you are using crutches, you may be able to use only one at around 9 weeks into your recovery.

    Overall, Every patient experiences a different rehabilitation process and your surgeon and physiotherapist will tailor-make a programme for you.

    Some patients find it beneficial to rent a secondary mobility aid such as a wheelchair to use as they recover. Having an aid other than crutches may make going out much easier and gives the hands and arms a chance to rest if they get sore.

    When can I begin exercising normally again after my hip osteotomy?

    The recovery process varies from person to person. Generally, the timeline for exercise can be longer for an osteotomy when compared to other procedures such as hip resurfacing or hip arthroscopy.

    Lower-impact activities like riding a static bike may be resumed after 10 or 12 weeks.

    For high-impact exercises (such as jogging), you will need to build up to these very gradually to ease your hip joint into the new movement and prevent any injury or damage. You should be able to fully resume high-impact activities at around 5 months. However, be aware this may take longer depending on how you heal.

    While returning to your usual exercise routine is a focus, your surgeon or physiotherapist may advise you to avoid certain activities altogether depending on the condition of your hip.

    It may take at least 6 months for you to return to some impact sports.

    The advice for returning to sexual activity varies, so make sure you ask your surgeon about this.

    Are there any alternative treatments to hip osteotomy?

    Alternative treatments for people with hip dysplasia include hip resurfacing (where metal ‘caps’ are used to recover the hip bones) and a total hip replacement (where the whole joint is replaced).

    Your surgeon will be able to discuss the potential alternatives with you at your consultation so you can make a decision that is best for you.

    Will I need physiotherapy after hip osteotomy?

    Anyone having a hip osteotomy will be given a tailor-made physiotherapy program. It is most important you follow this guidance. These exercises and instructions help ensure the lasting effect of your procedure and future health of your hip.

    Your physiotherapy will begin when you are in hospital then you will be given follow up appointments to attend as well as work to do when you are home.

    As your recovery progresses, you will require fewer physiotherapy and aftercare appointments. Many patients begin tapering off physiotherapy after about 2 or 3 months.

    How much time do I need to take off work after a hip osteotomy?

    The more physical your job, the more time your surgeon will advise you to take off.

    It may be ideal to take around 8 weeks if you can.

    However, if you work in an office, you may return to work after 3 to four weeks if your surgeon agrees that this is appropriate.

    If your work is physically demanding, you may need to be away from work for up to 4 months.