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Eric Eisner, MD, Pediatric Orthopaedic Surgeon and Hip Preservation Specialist
Joe DiMaggio Children’s Hospital Department of Orthopaedic Surgery and Hip Preservation Center
Most people have a friend or relative who has undergone a hip replacement operation. In fact, by 2030, the number of Americans who will require hip replacement surgery is expected to be nearly 600,000. However, many conditions that predispose a person to the development of arthritis can be identified and treated early in life. While most people do not think of arthritis as a problem that can be affected by preventative medical care, evaluation and treatment by a doctor with expertise in children’s hips can significantly help those patients at highest risk of developing a painful, arthritic hip. A simple way to think of the hip joint is to picture a round ball in a round socket. Imagine a tire on a car; if the tire is misshapen or the alignment is off then the tire will wear down early. The hip is similar. Any mismatch between the shape of the ball and the socket leads to early degeneration. Treatable hip conditions can present at any age, from birth through young adulthood. All newborns undergo a screening examination by a pediatrician to check for hip stability or hip dysplasia. The pediatrician is making sure that the ball (femoral head) is well positioned in the socket (acetabulum). An experienced provider can pick up even subtle abnormalities with a good physical exam. If the pediatrician is concerned about the baby’s hips, they will often refer the child to a pediatric orthopedic surgeon for confirmation and treatment. Ultrasound (no radiation exposure to the child) is used in newborns to provide more information about the shape and position of the hip. If necessary, noninvasive treatment is generally very successful, and aside from routine follow up exams during childhood, no surgical treatment is necessary. While many patients with abnormal hips will be identified as infants, other children may not show any symptoms until they become active toddlers or adolescents. The slow onset of pain around the hip in a school age child without any specific trauma or other illness may represent the first signs of hip dysplasia. Careful evaluation and treatment by a pediatric orthopedic surgeon is necessary to obtain a good, stable hip that can last a lifetime. In the older child, treatment may consist of close observation, bracing, or even surgery. Aside from dysplasia, several other hip conditions can also cause pain around the hip, groin, and even the knee. Bacterial infections in the hip joint represent a true emergency and require urgent treatment to prevent long term damage. More commonly, the body’s response to an upper respiratory infection, a condition known as transient synovitis, may cause pain in the hip and cause a child to limp. It can be difficult to differentiate between these two conditions, one of which is an emergency and the other of which resolves on its own. Evaluation by the child’s primary care provider, an ER doctor, or a pediatric orthopedic surgeon is essential to prevent any long term damage. Problems with the blood supply to the ball of the hip joint (Perthes disease) can present as the slow onset of hip pain, decreased hip motion, and a limp. Early treatment to preserve the shape of the ball while the blood supply is being reestablished can prevent problems later in life, including the development of painful arthritis. Another condition commonly seen in older children and adolescents is called slipped capital femoral epiphysis (SCFE). Essentially, the ball of the hip socket falls out of place. This can lead to severe deformity and a very rapid wearing down of the hip joint. The onset of symptoms may be very slow, but it can also occur suddenly, and surgery is required to prevent the progression of symptoms. Despite early recognition and treatment of many of these childhood hip conditions, some patients still develop a deformity of either the ball or the socket of the hip joint. Many of these patients are athletes who place high demands on their hips. In the past, these children were required to give up playing the sports they love and were destined to require a hip replacement at a young age. However, new surgical techniques have been developed to get these children back on the playing field, as well as significantly delay or altogether prevent the need for hip replacement. Pediatric orthopedic surgeons with specialized training in hip preservation surgery can perform procedures that relieve pain, improve function, and provide the patient with a healthy hip that can last a lifetime. Using both arthroscopic (minimally invasive) and open techniques these specialized surgeons have the opportunity to positively impact the lives of many patients. With early recognition and treatment of hip disease in young patients, the possibility exists that we can reverse the epidemic of hip arthritis that currently exists.
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