What is Hip Preservation?
Hip preservation refers to the use of nonsurgical or surgical means to protect a deteriorating hip joint in order to delay or avoid joint replacement surgery.
Hip preservation treatment seeks to solve symptoms or abnormal hip joint development. Abnormal hip joint development can show up in children or adolescents as they grow. Your child is likely to notice symptoms like weakness or pain in the hip.
The exact cause of abnormal hip joint development is not always known. Adolescent hip dysplasia (AHD) is a common condition that most likely stems from an undiagnosed or untreated case of developmental dysplasia of the hip (DDH) in childhood. These issues can go unnoticed during infancy and childhood and may not cause symptoms even when severe. AHD typically appears as a child grows and becomes more active in the early teen years. This can be the result of a rapid growth spurt, the need for the hip to bear more load as the child gets bigger, or increased activity.
The goals of joint preservation care promote your child's quality of life. The treatments and procedures offered at Gillette Children's Specialty Healthcare are meant to increase the stability of the hip, reduce impingement, alleviate pain, and prevent or delay the need for total hip replacement.
Hip Preservation at Gillette
Gillette has a long history of treating children with complex hip issues. We offer non-surgical treatments as well as surgical procedures to ensure your child gets the right care for their hip condition and joint issues and prevent future pain or injury.
Your child will receive care from an experienced, multidisciplinary team, which may include an orthopedic surgeon, arthroscopist, orthopedic APP and physical therapist - all trained in treating complex hip conditions in pediatric patients.
Conditions seen by our Hip Preservation experts include:
A dislocated hip occurs when the ball joint is moved out of its normal position from the hip socket. It can be corrected through surgery.
In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball at the upper end of the thighbone (femur) is loose in the socket and may be easy to dislocate from the pelvis.
Hip dysplasia occurs when the ball and socket joints of your child’s hip don’t fit or align correctly. Adolescent hip dysplasia is usually the end result of developmental hip dysplasia (DDH) that has been undetected or untreated. These patients may not show symptoms of hip dysplasia until reaching adolescence. It can be treated surgically or with brace treatment.
This condition occurs when the neck of the femur and the rim of the acetabulum improperly contact each other. This can be from extra bone growth on one or both of the bones that form the hip joint. Because they do not fit together perfectly, the bones bump into each other during movement. Over time this impingement can damage the joint, causing pain and limiting activity.
SCFE usually happens during preteen and teen growth spurts. In this condition, the ball of the hip slips from the femur bone creating pain and hip deformity. Surgery is needed to prevent further displacement.
Who benefits from Hip Preservation services?
Hip preservation is best suited for patients with AHD ranging in age from pre-teens through age 40. Infants diagnosed with DDH are also managed in this clinic.
Those who are most likely to have adolescent hip dysplasia include:
- First-degree relatives of someone already diagnosed with hip dysplasia (25 percent chance of developing hip dysplasia)
- Children with neuromuscular disorders
- Children with Down Syndrome
What can you expect from a Hip Preservation appointment?
In your child's initial Hip Preservation appointment, you can expect an evaluation of your child's hip joints by one of our expert orthopedic providers. From there, your care team will discuss observation, testing or treatment recommendations based on your child's individual needs.
In your child's follow up Hip Preservation appointments, your care team will continue to monitor the health of your child's hip joint. Further observation, especially following a surgical procedure may be necessary as your child continues to grow.
Full Spectrum Diagnostic Testing
Our specially trained pediatric orthopedic surgeons use the latest diagnostic techniques in their evaluation of your child’s hip needs. Tests may include ultrasound, arthrography, magnetic resonance imaging (MRI), gait analysis, and EOS low-dose x-ray imaging. The EOS provides 3D analyses to assist our orthopedic surgeons in understanding the source of your child’s hip pain and optimizing treatment.
Hip Preservation Treatments and Procedures
In some instances, joint preservation of the hip can be achieved without surgery. When the joints are stable enough to recover on their own without the risk of displacement, they can be rested for a certain period of time, allowing them to heal naturally. Crutches or a cane may also be used to help unload an affected joint as it heals.
Other nonsurgical recommendations may be right for your child, including:
- Activity modifications
- Physical therapy
- Anti-inflammatory medications
- Diagnostic and/or therapeutic injection
In most cases, joint preservation of the hip requires surgery. The aim of most hip preservation procedures is to repair any bone damage and reconnect any broken bones or torn ligaments that may disrupt the proper function of the joint. Most hip conditions and joint issues are treated surgically through one of the following techniques:
A procedure that uses metal plates, screws or pins to stabilize displaced bones so they can heal correctly. In many instances, the plates and rods are not surgically removed once the healing process is finished.
A procedure in which a small camera, called an arthroscope, is inserted through a small incision to see inside the injured area. Using this guidance, the surgeon can clear out or repair damaged tissue, allowing the joint to heal properly.
Arthroscopic procedures may include:
- Labral re-fixation: In this procedure, the doctor trims the torn and frayed tissue around the acetabular rim and reattaches the torn labrum to the bone of the rim.
- Laboral reconstruction: If the labrum is damaged beyond repair, it can be removed and replaced by a piece of tendon.
- Debridement: In rare cases, simply removing the torn or weakened labral tissue can provide pain relief.
A procedure to realign the bones of the joint to bear weight on the normal joint cartilage. This allows the joint to endure less stress, which reduces symptoms of dysplasia or osteoarthritis. The most common surgery for adolescents and young adults with hip dysplasia is periacetabular osteotomy (PAO). This is a procedure in which the acetabulum is cut free from the pelvis and then repositioned so that it is properly aligned. Arthroscopy can be done in conjunction with PAO.
After Surgical Treatment
For patients who are in the teen to adult years, rehabilitation after surgery typically consists of six months of physical therapy. Individuals often return to selected activities in four to six months. Overall recovery continues up to one year. The most intensive part of recovery is in the first three months after surgery.
Making an Appointment
Patients can get an appointment through self-referral or referral by their primary care provider or specialty provider. Please call us at 651-310-1807 to schedule a Hip Preservation appointment.