“My son Michael was 22 months old and walking, but suddenly he resorted to crawling again,” recalls Michael’s mom, Gina Tartaglia, MD, who is also a general practitioner. “As a healthcare professional and parent, I knew something was wrong.”
Legg-Calvé-Perthes disease is a condition associated with an inadequate blood supply to part of the hip joint, specifically the top of the femur bone called the femoral head. Without sufficient blood flow, the femoral head may become unstable, break easily, and heal poorly. Although Legg-Calvé-Perthes disease can affect children of nearly any age, it is diagnosed typically in boys, ages four through nine.
“It is not a common childhood disease, and it is one that often leads to severe osteoarthritis and related problems in adulthood,” explains Daniel W. Green, MD, MS, FAAP, FACS, associate attending orthopedic surgeon at Hospital for Special Surgery.
Starting at age two, Michael battled his hip disease with a regimen of thrice-weekly physical therapy sessions to help improve his mobility. Eventually he was able to run, jump, and participate in sports like tae kwon do. By age seven, however, Michael’s hip began to worsen.
“Upon our first visit to HSS, we knew we were placing our son in very capable hands,” says Dr. Tartaglia. Michael’s declining condition was evaluated by Leon Root, MD, a pediatric orthopedic surgeon and former chief of pediatric orthopedics at HSS, who confirmed the original diagnosis of Legg-Calvé-Perthes disease.
The diagnostic assessment included an arthrogram—a series of radiographic images of the joint following dye injection—which revealed evidence of a loose piece of bone, about the size of a piece of popcorn, floating inside his hip joint.
“He had a prominent limp, mild limb length discrepancy, and was in a great deal of pain,” says Dr. Root. “Once the loose body was discovered, surgery was recommended as the best course of action.”
Less invasive than traditional hip surgery, hip arthroscopy is an ambulatory procedure using small incisions. A camera, used to visualize the joint, is inserted into one incision, and surgical instruments are placed through the other incisions. Because the procedure is commonly performed in adult patients, the pediatric team enlisted the help of Bryan T. Kelly, MD, co-director of the Center for Hip Pain and Preservation and a specialist in hip arthroscopic surgery at HSS. Working together, Drs. Green and Kelly performed the outpatient surgery on Michael’s hip. Michael then had physical therapy.
One year later, Michael is a busy third grader who can keep the pace with his parents and two big sisters, friends, and members of his martial arts class. Although he requires a follow-up hip procedure, Michael says he will do what it takes to keep moving without pain. “I was a nervous [about surgery] but I’m glad I did it,” says Michael. “I am a lot better and can do what I like to do without limping or feeling the hurt.”
As Michael’s case and countless others like it become more prevalent, physicians at HSS have recognized the need to provide highly specialized services for children with complex hip problems.
This year, HSS pediatrics welcomes Ernest L. Sink, MD, a renowned expert in adolescent hip preservation, who will collaborate with the Center for Hip Pain and Preservation to provide our youngest patients with help and hope for pain-free mobility.
“With the appointment of Dr. Sink,” explains Dr. Green, “the HSS Pediatric Orthopedic Service’s collaboration with the HSS Center for Hip Pain and Preservation will continue to grow. This team approach between the pediatric and adult services will result in unprecedented therapy and surgical intervention options for infants, children, and young adults with pediatric hip disorders.”
For more information about hip preservation and treatment for children, visit the HSS pediatric website.