Periacetabular Osteotomy for Hip Dysplasia in a NCAA Division I Female Water Polo Athlete

Abstract

OBJECTIVES The purpose of this study is to investigate the effect of applying a very minimal weight bearing in the early phase of a general rehabilitation program for returning to sports after periacetabular osteotomy for developmental dysplasia of the hip in physically active populations.METHODS A 22 year-old NCAA Division I female water polo player, with no prior history of hip injury and no signs of developmental dysplasia of the hip (DDH), reported to athletic training facility early season complaining of right hip pain after stationary bike workout. The athlete reported hearing and feeling a sudden “pop” within the right hip with immediate hip pain when she was pedaling at moderate intensity of a stationary bike. Numbness and tingling was felt initially with the mechanism. Tender to palpate at the right hip flexor and anterior hip joint, as well as the greater trochanter. The athlete’s chief complaints were pain with walking and prolonged sitting. Antalgic gait noticed during evaluation. A 6-, 12-, and 24-week rehabilitation protocol were performed.RESULTS X-ray and MRI images showed no avascular necrosis or fracture. An abnormal alpha angle found and no bursitis or tendonitis was shown. A periacetabular osteotomy (PAO) was performed to rotate the acetabular fragment into optimal position and fixed to the pelvis with 3 screws. During the initial 6-week of post-surgical rehabilitation, the level of pain and edema were minimized, the athlete was able to perform toe-touch and partial weight-bearing with crutches, and restored hip ROMs. From 6 to 10 weeks, the athlete recovered full hip ROMs and able to perform lunges, leg press, deadlifts, mini squats back to pre-injury status. The athlete was able to return to activities of daily living (ADLs) after 12 weeks. At 24 weeks, the athlete was able to fully participate in sports without limitations.CONCLUSIONS This case describes the rehabilitation program employed following PAO for an atypical case of DDH in a water polo athlete who had no signs and symptoms of DDH prior to sports participation. At the end of the season, the athlete opted to undergo PAO given the risks and underwent a 6-month rehabilitation before a full return to function. This case report aides with treatment knowledge and postsurgical rehabilitation techniques for athletic trainers.