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Rise of the Hip Specialist: Symposium Discusses Breakthroughs in Treatments for Hip Conditions

Childhood disorders can lead to arthritis later so focus is on preserving the hip joint

New York—October 24, 2012

One of the fastest growing fields in orthopedic surgery is that of a hip specialist. To cater to this burgeoning field, a recent symposium with Hospital for Special Surgery brought together international experts in hip surgery to provide a comprehensive overview of recent advances and trends in treating a range of hip disorders.

Selected research from the summit is published in the September issue of the HSS Journal, the Musculoskeletal Journal of Hospital for Special Surgery.  One of the studies is provided with open access online and the others are available free of charge through Dec. 1, 2012, at http://www.springerlink.com/content/1556-3316/8/3/.

“The meeting is a comprehensive look at a wide spectrum of hip disorders, from conditions that affect children, to things that affect adolescents and young athletes, going all the way up the spectrum to arthritis and degenerative conditions,” said Edwin Su, M.D., an orthopedic surgeon in the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery in New York City. “It is important to understand that these things are all related. A disorder that happens in children can lead to arthritis later, which is why there is a lot of focus on trying to preserve the hip joint.”

In recent years, a growing number of academic centers have begun to open specialized hip centers, in which several physicians provide a continuum of care for various hip conditions that impact individuals of varying ages. The Joint Preserving and Minimally Invasive Surgery of the Hip Symposium has been held nine times since 2001. This most recent meeting was a collaborative effort between Hospital for Special Surgery and the University of Ottawa, Ottawa, Canada.

“This is a collaborative effort between two academic centers who have a number of hip specialists and have frequent discussions about these conditions,” said Dr. Su. “But this gathering involved international researchers, so it was also an international collaboration.”

A large number of studies in the special HSS Journal issue discuss new research avenues for treating osteoarthritis of the hip, including advances in hip replacement. Osteoarthritis is now the number one cause of disability in the United States. HSS researchers discuss the ideal size of the head of the hip replacement, and experts from Sydney Hip and Knee Surgeons, North Sydney, New South Wales, Australia, discuss the pros and cons of using ceramic-on-ceramic materials in hip prostheses.

While metal-on-metal hip replacements have fallen out of favor in recent years due to adverse effects, a study by French researchers at the University of Lille, Lille, France, shows that the use of metal-on-metal bearings should not be discarded and provides favorable outcomes.

Another study performed by researchers from the University of Lille on behalf of the French Orthopedic Society, Lille, France, identified a new treatment to prevent total hip replacement dislocation.

Investigators from the University College London Hospitals describe a new assessment tool, a hip score, to evaluate the success of hip procedures. Current instruments are unable to differentiate between a high performing hip replacement and a routine hip replacement, and the new score could help.

The special hip journal issue also focuses a great deal of attention on treatments for hip impingement, otherwise known as femoroacetabular impingement (FAI). “Treatment of FAI is one of the most rapidly growing surgeries in hip surgery,” said Dr. Su.

FAI is caused by abnormal contact between the ball and socket of the hip joint, which causes friction during hip movements that can damage the joint. “As we have developed imaging techniques and an understanding of the pathology of FAI, our ability to treat these problems has increased,” said Dr. Su. “There is the promise of trying to prevent the development of arthritis in patients with FAI.”

A study by investigators at the Mayo Clinic, Rochester, Minn., concludes that surgical hip dislocation should be used to treat FAI only in specific patients over the age of 40, those who do not have joint degeneration. Another project by scientists from the University of Berne, Berne, Switzerland, and the Schulthess Clinic, Zurich, Switzerland, showed that patients had better outcomes when surgeons treating FAI made attempts to preserve the ring of cartilage that surrounds the hip joint socket rather than remove it.

Other studies discuss the phenomenon of groin pain after hip resurfacing (University of Ottawa) and validate using cementless hip resurfacing (University of Lille). “Hip resurfacing is done for arthritis, but is generally done in younger patients. The average age for a hip replacement is mid 60s and the average age for resurfacing is about 50,” said Dr. Su.

The Center for Hip Preservation was established at Hospital for Special Surgery in 2010. It aims to provide care for patients of all ages with hip pathology, ranging from developmental dysplasia of the hip, to sports-related injuries, to degenerative arthritis. Physiatrists, pediatric orthopedic surgeons, sports medicine surgeons, and arthroplasty surgeons all practice in the center, allowing for a spectrum of non-operative and operative treatments.



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