What is Hip Preservation?
Hip preservation refers to nonsurgical or surgical means to protect a deteriorating hip joint 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 signs 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 result from a rapid growth spurt, the need for the hip to bear more load as the child gets bigger, or increased activity.
The goal of joint preservation care promotes your child's quality of life. The treatments and procedures offered at Gillette Children's can 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 and surgical procedures to ensure your child gets the proper 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. The hip preservation specialists at Gillette are experts in the field.
Conditions seen by our Hip Preservation experts include:
A dislocated hip occurs when the ball at the top of the thigh bone (femur) moves out of its normal position from the hip socket. It can be corrected through bracing or surgery.
In babies and children with developmental dysplasia of the hip (DDH), the hip joint has not formed normally. The socket is likely to be shallow, which makes the ball at the top of the thigh bone (femur) loose in the socket.
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 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 physical therapy.
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 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 also can be managed in this clinic but are often treated by others on the Gillette orthopedics team.
Those who are most likely to have adolescent hip dysplasia include:
- First-born children
- Children who were born breech
- 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 to evaluate your child’s hip needs. Tests may include ultrasound, arthrography, magnetic resonance imaging (MRI), gait analysis, CT scan and EOS low-dose x-ray imaging. Many of these imaging tests provide 3D modeling 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 cases, hip surgery is not needed. When the joints are stable enough to recover on their own without the risk of displacement, they can be rested for a certain time, allowing them to heal naturally. A person can also use crutches or a cane to help unload an affected joint as it heals.
Other nonsurgical recommendations may be suitable for your child, including:
- Activity modifications
- Physical therapy
- Anti-inflammatory medications
- Diagnostic or therapeutic injection
In many cases, hip preservation surgery is needed. The aim of hip preservation procedures is to repair any damage to the soft tissues while reshaping or reorienting bones that are malpositioned and 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 to heal correctly. In many instances, the plates and rods remain in the body after healing.
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 acetabular 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 procedure allows the joint to endure less stress, which reduces symptoms and further damage resulting from dysplasia or impingement. The most common surgery for adolescents and young adults with hip dysplasia is periacetabular osteotomy (PAO). During this procedure, the acetabulum is cut free from the pelvis and then repositioned to be correctly aligned. Arthroscopy can be done in conjunction with a PAO.
After Surgical Treatment
For patients in their teen or 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 651-290-8707 to schedule a Hip Preservation appointment.
The Gillette Hip Preservation providers have extensive clinical expertise in treating and managing hip conditions. Because we see the full spectrum of hip disorders, from mild to severe, all patients benefit from our depth of experience, no matter their complexity.