Hip Disorders Approach (Adolescents)


 

HIP DYSPLASIA

Hip pain in adolescents and adults is quite common. There are many causes and the most important factor is determining the reason and cause of the pain. Pain in the hip can be as a trauma as simple as a muscle strain or sprain, to an overuse injury such as a stress fracture, to loss of blood supply called avascular necrosis, to a hip that developed too shallow (hip dysplasia) to a hip that may be mal-oriented or too deep and causing hip impingement.  


Therefore hip pain cannot be lumped into one and each condition has its own unique management features. For instance, a hip sprain many need exercises and physical therapy while hip dysplasia requires surgical reconstruction of the hip.


Having reconstructed over 600 such hips in my career, it is very possible to eliminate the pain and the limp associated with this problem. Surgical solutions such as a Triple Innominate Osteotomy in childhood or the similar osteotomy popularized by Reinhold Ganz and minimally invasive femoral rotational osteotomies are specialized procedures that preserve the hip and are performed in very few centers in the US. If one were simply to repair the labrum, the tear will occur again due to the abnormal mechanics of the hip. The best management if there is a torn labrum is to utilize hip arthroscopy to repair the labrum and then perform a periacetabular osteotomy to repair the mechanical problem of the hip. If this is performed before arthritis has set in, the patient can be pain free for many years and in many cases never needing a hip replacement. A torn labrum with or without hip impingement can often be treated by hip arthroscopy.


AVASCULAR NECROSIS OF THE HIP

Early diagnosis and vigilant management of avascular necrosis of the hip increases the possibility of a full or at least partial recovery. There are many treatment options and a surgeon should have experience with all of them to ensure that each hip and patient receives thorough treatment based on their individual condition. The longer the hip remains untreated or treated inadequately, the greater the likelihood of developing arthritis and the subsequent need for a hip replacement.


Non-surgical Treatment

Adolescents and adults with mild forms of avascular necrosis may benefit from crutches, physical therapy, and/or medication such as bisphosphanate. However, management of the disease by adjusting treatment based on x-rays and the hip’s range of motion is essential.


Surgical Treatment

While there are many options, the best course of treatment should be determined on an individual basis and take into account the stage and severity of the disease. In most cases, a multi-faceted approach to treatment is required to preserve and save the hip. Additionally, the use of an intravenous bisphosphanate, such as Zoledronate, may increase the possibility of saving the femoral head.


  • Core Decompression

In the early stages of adult avascular necrosis of the hip, the surgical removal of dead bone and tissue can help to stimulate the growth of new bone and revascularize the hip. To be most effective, core decompression is typically combined with other treatment methods.


  • Femoral Head Reduction Surgery

A femoral head that is misshapen may require surgery if the deformity causes pain or impacts a patient’s ability to walk. The surgical procedure involves using screws and bone grafts to reshape the femoral head into a more “normal” round shape.


  • Distraction of the Hip (Arthrodiastasis)

Arthrodiastasis involves separating the parts of the hip joint while keeping ligaments and tendons intact. The procedure allows the components of the hip to be properly spaced and aligned. Few surgeons perform this surgery but when prudently prescribed for the right patient and used in conjunction with other treatments it can preserve a hip that might otherwise be unsalvageable.


  • Hip Replacement

Hip preservation should be the main goal of treatment, especially in patients under 40 years of age. Hip replacement should always be a last resort reserved for after all other treatments have been thoroughly considered and found to be inadequate. Hip replacement involves replacing the hip’s damaged bone and cartilage with prosthetics.


*Please note that I do not perform hip replacement surgeries.


SLIPPED CAPITAL FEMORAL EPIPHYSIS

Early diagnosis and treatment of slipped capital femoral epiphysis increases the likelihood of successfully stabilizing the hip and preventing the development of more severe hip conditions. Treatment typically consists of surgery to hold the components of the hip in proper position and/or removal of the growth plate to prevent further displacement.

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David S. Feldman, MD
901 45th Street, Kimmel Building
West Palm Beach, FL 33407
Phone: 561-264-2141
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