Child and Young Adult Hip Preservation
The Hip Preservation Program at Children’s Memorial Hermann Hospital provides management of hip-related conditions for patients from birth through young adulthood. The affiliated pediatric orthopedic surgery and sports medicine team provides patients with a full range of operative and nonoperative management techniques to treat hip-related conditions, including hip arthroscopy, complex hip osteotomies, and treatment for sports-related hip injuries.
With the hospital’s unique collaboration with McGovern Medical School at UTHealth, a team of fellowship-trained pediatric orthopedic and a dual-fellowship trained Sports Medicine surgeons specialize in the care of young children and young adults at Children’s Memorial Hermann. This affiliated team employs the latest technology to offer minimally invasive care whenever possible, resulting in the best individualized care based on each diagnosis.
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Hip Preservation Online Presentation
- Infantile hip dysplasia (DDH)
- Neuromuscular hip dysplasia
- Slipped capital femoral epiphysis (SCFE)
- Femoroacetabular impingement (FAI)
- Legg-Calve-Perthes (LCP or Perthes)
- Adolescent and young adult hip dysplasia
- Coxa valga
- Coxa vara
- Snapping hip
- Sports-related hip injuries
- Post-traumatic deformities
- Femoral anteversion
- Avascular necrosis
What is hip dysplasia?
Hip dysplasia (developmental dysplasia of the hip or DDH) occurs when the hip socket does not fully cover the ball of the hip joint, allowing it to become partially or completely dislocated. This failure of the hip joints to develop normally results in gradual deterioration, leading to loss of joint function and arthritis. The symptoms of dysplasia are very subtle in infants and young children up to about age eleven, because the child typically feels no pain associated with the condition. Before a baby starts to walk, symptoms may include:
- A “click” in the hip often noticed when changing a diaper or moving the child’s legs
- Legs that are different lengths
- Mismatched rolls on the thighs
- One leg that opens wider than the other when the baby is in a “frog” position
After a child begins to walk, parents may notice a lurching or waddling gait or a limp, none of which are accompanied by pain. Older children (11 and up) and young adults with hip dysplasia often develop pain they have not felt earlier, although the condition may have been present since birth. Patients may have been treated for hip dysplasia as babies, but in most cases have not been previously diagnosed or treated. The cause may also be a hip injury or other childhood problem that results in delayed complications.
Screening and Diagnosis
Early awareness of hip dysplasia is extremely important because the best opportunity for minimally invasive treatment is when the condition is diagnosed before a child starts to walk. Screening as early as possible is advised for babies with a family medical history of DDH, placing them at a higher risk, or those who display any of the symptoms of dysplasia.
A physical exam by a pediatrician or orthopedist may include an ultrasound scan for babies up to 4 months old; after 4 months, X-rays are generally used to spot dysplasia in bones that are more developed.
Treatment of hip dysplasia in young children depends almost entirely on the child’s age at diagnosis. The earlier it’s detected, the less invasive the necessary treatment; for babies, a soft brace, harness, body cast or spica cast can often correct the condition without surgery. If the initial approach is unsuccessful for children who have not yet started to walk, surgical placement of the hip into the socket may be necessary. After a child starts walking, treatment usually requires surgery. A procedure called an open reduction involves opening up the hip socket. Tissue that prevents the hip from being in position is removed and the hip is carefully placed into the socket.
In hip dysplasia cases that require more extensive repair, the surgeon may perform an osteotomy, a surgical procedure in which the femur (the ball side of the hip joint) or the pelvis (the socket side of the hip joint) is cut and realigned so it can grow into a normal position. For six to twelve weeks after the surgery, the child wears a cast and is not allowed to walk. After the tissues heal with the hip in the new position, the child resumes walking. Follow-up X-rays, taken until the patient reaches young adulthood, ensure that the hip continues to develop in the correct place.
Treatment options include:
- Hip arthroscopy
- Surgical hip dislocation
- Relative neck lengthening
- Open treatment of slipped capital femoral epiphysis (SCFE)
- Periacetabular osteotomy (PAO)
- Pelvic and proximal femoral osteotomies
- Bone grafting
- Physical therapy
The presence of hip dysplasia initially is not painful. During teenage years, it becomes apparent typically because of activity-related pain. Symptoms include:
- Aching or soreness that often feels like a muscle pull
- Alterations in gait or a limp
- Limitations in function
- Pain in the hip, groin or knee
Pain is usually not constant but is recurring. After exercise, athletics or similar activities, children may develop a minimally painful limp that improves with rest. Parents may see the child grab a hip in the cleft between the thumb and fingers (the “C” sign) and describe a dull ache in the area. Before the abnormality is discovered, hip dysplasia is frequently minimized, and can be misdiagnosed as a hip strain or pulled muscle.
Diagnosis and Treatment
In older children and young adults, hip dysplasia is generally diagnosed using X-rays followed by advanced imaging – a CT scan or MRI – that provides a more detailed look. The ultimate goal of treatment for older children and young adults is a pain-free hip that is not at increased risk of needing a hip replacement at an early age (30’s or 40’s). Initial treatment may include:
- Activity modification
- Anti-inflammatory medication to control pain
- Physical therapy
If a patient does not respond to these approaches, the underlying malformation may require surgery to change the shape of the hip socket or repair structures damaged by overuse.
- A femoral osteotomy, which involves cutting the bone of the femur side, may be used to correct abnormal growth caused by dysplasia.
- An acetabular osteotomy may be used for cases that require more extensive repair. In this procedure, the surgeon cuts the pelvis on the socket (acetabular) side of the joint and reorients the hip socket into a more normal position.
- Minimally invasive arthroscopy allows the surgeon to repair damaged tissue around the hip by making two or three small incisions and inserting a small camera and specialized instruments.
After arthroscopic surgery, many patients go home the same day and can generally return to normal activity after about four months. The typical hospital stay for osteotomy patients is two to three days, with about six months before they return to normal activity. Patients who have undergone any of these procedures usually walk on crutches for about two months and undergo about six months of specialized rehabilitation, including physical therapy. Patients generally require follow-up X-rays at one- to five-year intervals. Long-term care also includes careful attention to potential development of arthritis.
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