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Osteopathic Management of Chronic Pain Following Bilateral Periacetabular Osteotomy in Developmental Hip Dysplasia

Journal: The AAO Journal Date: 2024/06, 34(2):Pages: 19. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/16/500954/LBORC-NUFA-Poster-Abstracts-2024-Students)

Keywords:

case report [710]
chronic pain [296]
female [607]
hip dysplasia [8]
lower extremities [26]
OMT [3752]
osteopathic manipulative treatment [3772]
osteotomy [1]
post-operative care [73]
women [562]

Abstract:

Introduction/Background: When diagnosed in late adolescence, the treatment of choice for hip dysplasia is periacetabular osteotomy (PAO) and post-operative physical therapy (PT). However, postsurgical compensatory changes can result in femoral anteversion (FAV) and resultant femoral acetabular impingement (FAI) which increases the risk of early-onset osteoarthritis and the need for total hip replacement (THR) in young patients. Case: A 26-year-old female presents with chronic right lower extremity (RLE) pain. She was diagnosed with bilateral hip dysplasia at 13 years old. She received a right and left PAO at age 14 and 15 respectively with PT with 90% pain reduction. By age 19, right hip pain returned. She restarted PT by age 22 which achieved 50% pain reduction. At age 23, X-rays showed Tonnis grade 2 and 3 osteoarthritis of the left and right hip, respectively. Analgesics and PT were recommended until THR is indicated. Her initial osteopathic exam at the age of 26 was significant for FAV and FAI based on verbal pain scales, log roll, FADIR, range of motion, and postural and functional biomechanics. Methods: Osteopathy in the Cranial Field, Balanced Membranous Tension, and Ligamentous Articular Strain were applied to correct intraosseous strains, capsular compression, and myofascial strains. Following one treatment session, 90% pain reduction and resolution of postural FAV and FAI at rest were achieved. However, some proprioceptive strains persisted functionally. Treatment plans include further osteopathic re-evaluations, OMT, exercise prescription, and gait retraining with PT if needed. Conclusion: Motion freedom was maintained at 4 weeks, despite a gradual return to 50% of original pain after a prolonged car ride. This case illustrates the benefit of osteopathic management following PAO to decrease pain and correct postsurgical compensatory changes.


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