Hip Preservation in Children and Young Adults

Adapted from the Summer 2011 issue of Pediatric Connection


Ernest L. Sink, MD

Ernest L. Sink, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College
Associate Attending Orthopaedic Surgeon, NewYork-Presbyterian Hospital
Co-Director, Center for Hip Preservation, Hospital for Special Surgery

Hip preservation is a relatively new concept in pediatric and young adult orthopedic surgery.

The goal of hip preservation treatment is to delay or prevent the onset of end stage hip osteoarthritis. Strategies to halt the progression of hip osteoarthritis in young adults are important, as the condition can lead to significant discomfort and poor quality of life. In these individuals, a joint replacement is often the only solution. Although a hip replacement has an excellent outcome, there is concern for the longevity of the artificial joint, especially in the young and active patient. Therefore, it is optimal to avoid or postpone hip joint replacement surgery.

Bony abnormalities in either the femoral head or the acetabulum (hip socket) can result in hip pain and cartilage injury, which leads to osteoarthrosis. These bony deformities are often the result of childhood hip disorders such as developmental dysplasia, Legg-Calvé-Perthes disease, or slipped capital femoral epiphysis. A relatively new concept called femoroacetabular impingement (FAI) describes abnormalities of the femoral head or acetabulum that cause hip pain and cartilage injury while the hip moves with sporting activities.

Theoretically, hip preservation begins in the newborn with the diagnosis and treatment of hip dysplasia. Hip dysplasia in a skeletally immature child can be managed with a variety of bony surgical procedures on the pelvis and acetablulum.

In adolescents and young adults, novel surgical techniques have been developed to improve the bony abnormalities that can lead to hip osteoarthritis. The following are the latest surgical techniques in hip preservation:

  • The periacetabular osteotomy is used for skeletally mature hip dysplasia. In this procedure, the acetabulum is reoriented after a series of bony cuts around the acetabulum. This surgery has great potential to prevent or delay hip osteoarthritis, particularly if it is performed prior to irreversible cartilage injury. 
  • Surgical dislocation of the hip allows complete visualization of the femoral head and acetablum. This exposure is utilized in the treatment of various complex hip deformities. With this approach, there has evolved improved treatment of hip impingement, slipped capital femoral epiphysis, and painful Legg-Calvé-Perthes disease. 
  • Hip arthroscopy has advanced in the last few years. In carefully selected patients, arthroscopy has the potential to treat hip disorders in a minimally invasive fashion.

The Pediatric Orthopedic Service and the Center for Hip Preservation at Hospital for Special Surgery provide comprehensive care for all hip disorders, from newborns to young adults.

 

Learn more about Pediatric Connection, the HSS pediatric musculoskeletal newsletter.

^ Back to Top

Newsroom

Request an Appointment