Hip Preservation
Hip problems can occur at any age, from newborn through adulthood. It can be related to a congenital or developmental problem of the hip joint. Hips also can be injured during sports activities or because of trauma.
At SSM Health Cardinal Glennon Children’s Hospital, we have pediatric orthopedists who specialize in diagnosing and treating common and complex hip disorders. Our SLUCare Physician Group specialists also focus on hip preservation to minimize the risk of chronic pain or stiffness and/or the development of arthritis later in life.
Any hip pain lasting more than two weeks should be evaluated by a pediatric orthopedist. It also is important to point out that hip problems can result in pain in other areas of the body, including the knee, groin, or lower back. A comprehensive evaluation is needed to determine the source of the pain.
Conditions We Treat
Development Dysplasia of the Hip (DDH)
Also called Infantile hip dysplasia, this condition occurs in infants and children when their hip joint forms abnormally. The ball and socket of the hip joint is loose because the socket is too shallow to hold the top of the femur (ball) firmly in place. When it is diagnosed in older children, it is called adolescent hip dysplasia (AHD). The condition is more common in females than males and is often treated with physical therapy or surgery.
Femoroacetabular Impingement (FAI)
Also called hip impingement, FAI is a common condition in adolescents in which one or more bones of the hip are abnormal, causing friction to occur between the thighbone (femur) and hip socket. It is usually characterized into three main types:
- Cam impingement – when the femur is abnormally shaped, causing a bump in the top of the thighbone that can potentially damage cartilage
- Pincer impingement – when the hip socket is too deep or turned, causing a pinching of the cartilage during movement
- Hyperlaxity – an excessive range of motion in the hip that when combined with abnormal bone growth, also can result in pinched cartilage and pain.
Labral Tears
Damage to the ring of cartilage (labrum) that covers the hip joint socket can be caused by trauma, anatomic abnormalities, or be the result of repetitive motions that lead to joint wear and tear. The cartilage is important for motion and flexibility and helps to cushion the joint during movement. When a tear occurs, children may experience a sharp pain or clicking sensation.
Sports-Related or Traumatic Hip Injuries
Any activity that involves a repetitive motion of the hip or extreme flexing of the joint could result in a hip injury. Activities include running, gymnastics, dance, and weightlifting, to name a few. A severe injury because of trauma also can damage the hip bones.
Femoral Anteversion/Femoral Retroversion
An abnormal angle or rotation of the hip joint. Femoral anteversion occurs when the femur has an inward, or forward rotation. Retroversion occurs when the femur is twisted backward in relation to the knee. The two conditions can occur in one or both legs. Some of the common symptoms for hip malrotation including delayed walking during development, or “duck walking,” with children walking with their foot pointed outward. Flatfeet are another symptom.
Coxa Valga/Coxa Vara
Coxa Valga and Coxa Vara are hip deformities occur when the angle formed by the head of the femur and the bone itself is abnormal. The type is determined by the extent of the tilt.
Slipped Capital Femoral Epiphysis (SCFE)
Slipped Capital Femoral Epiphysis (SCFE) is a disorder that occurs in adolescents when the growth plate in the upper femur is damaged, causing the head of the femur to slip out of alignment with the rest of the thighbone. It may develop over time or happen suddenly. In half of all cases, SCFE is diagnosed in both hips. In addition to hip pain, children may limp and/or experience pain in the groin, thigh, or knees.
Legg-Calve-Perthes (LCP) Disease
Legg-Calve-Perthes (LCP) Disease is a condition that develops when there is a temporary loss of blood supply to the femur bone. Without blood, the bone becomes weak and brittle. While the body can eventually restore blood flow, the condition causes the top of the femur (ball) to develop an abnormal shape. The process of bone loss and renewal takes place over several years and must be managed properly to prevent permanent injury and minimize the risk of hip arthritis.
Hip Infections & Post-Septic Sequalae’s of the Hip Joint
These infections, although uncommon in children, occur when bacteria, viruses, or fungi get into bones or joints, leading to pain and loss of movement. The overwhelming majority of cases are treatable with pediatric orthopedists working together with infectious disease specialists. In complex cases, we have expertise in hip reconstruction for children whose hip joint is destroyed by the infection.
Treatment Options
With any hip pain or chronic instability, a thorough exam is necessary. Imaging tests, including X-rays, ultrasound, CT or MRI scans, or imaging scans with and without contrast may be ordered. Depending upon the severity of the problem, treatment options include rest and activity modifications, physical therapy, hip injections (steroids) and other medications as well as surgery. Surgical options for children are designed to preserve hip function as much as possible. They include re-aligning bone; repositioning of the hip socket, cartilage repair, labral tear repair, and treatment of microfractures. Many of these procedures are minimally invasive. SSM Health Cardinal Glennon also has a 3D Printing Center of Excellence, which allows pediatric orthopedists the opportunity to print anatomic models for pre-surgical planning, which enhances the overall accuracy of complex surgeries.
Hip Arthroscopy
This is a minimally invasive procedure that enables doctors to both view and repair the hip joint through just a small incision. It is used to diagnose and treat a variety of hip problems. Because it is a minimally invasive procedure, children have a shorter recovery period before they can return to activities and typically have less pain and stiffness.
Femoral Osteotomy
This is a procedure that corrects deformities of the upper leg bone (femur). It can be done as a single procedure or in combination with hip dysplasia treatment. In most cases, the femur is cut to correct the deformity and then is stabilized with an implanted plate or nail.
Pelvic Osteotomy
This procedure stabilizes the hip and involves reshaping a shallow hip socket so that the ball of the hip joint fits properly. The procedure better preserves the hip joint and reduces the risk of arthritis later in life. There are various types of osteotomies to reorient or redirect the socket, depending upon the pathology and the patient’s age.
Periacetabular Osteotomy (PAO)
This is the most common procedure for both adolescents and adults with hip dysplasia with or without a labral tear. This involves making several small cuts to the bone around the hip socket to enable the surgeon to rotate the socket into the right position. Once that is completed, the surgeon will then insert metal screws to hold the bone in place. If done correctly, the procedure preserves the hip joint while also decreasing the risk of arthritis developing later in life.
Expertise
At SSM Health Cardinal Glennon Children’s Hospital, we have excellent outcomes with our hip preservation and surgical procedures. We also participate in multi-center research efforts to improve patient care and outcomes. Read
Atilla, H. A., Raju, S., Akdogan, M., Ozturk, A., Bilgetekin, Y. G., & Kose, O. (2021, May 5). Rear drop: A new radiographic landmark for estimation of pelvic tilt on pelvis ap radiographs.Journal of Hip Preservation Surgery, Volume 8, Issue 1, January 2021, Pages 58–66 https://academic.oup.com/jhps/article/8/1/58/6268987