A Long Island brother and sister are giving new meaning to the saying, "all in the family." Justine and Michael Miano are close siblings from Stony Brook who share more than a great sense of humor and outgoing personalities. They both had operations on the same day at Hospital for Special Surgery (HSS) to repair similar hip problems that had caused discomfort and limited their activities for years.
Sixteen year-old Justine Miano and her 21-year-old brother Michael suffered from hip pain for as long as they could remember. When they were children, their pediatrician dismissed it as "growing pains." But as they got older, it didn't go away, and certain activities made it worse. "Some doctors diagnosed their problem as a muscle strain," says their mother, Regina Miano. "They told me to leave it alone."
"Ever since I was young I had hip pain," Justine says. "It was mostly groin pain. Sometimes it was excruciating, and I had trouble walking." Five years ago, Justine's right leg gave way and she collapsed. An x-ray was taken, but it did not show a problem, according to her doctor. She had undergone surgery to stabilize a slipped growth plate in one hip at the age of 11, but the source of her continued pain in both hips remained elusive.
Her brother Michael, who was always active in sports, had similar pain. "I had the pain for as long as I can remember," he says. "But I got so used to it that I stopped complaining." By the time Michael was in his second year of college, it was getting really bad, especially after playing lacrosse or another favorite sport. "I felt this extreme soreness. It was an immense dull pain in my core. Worse than a pulled muscle. I had flare-ups, and it was painful to walk after certain activities."
In 2006, Michael and his mother decided they had to get to the bottom of it. They consulted with a Long Island orthopedic surgeon who had an idea of what was causing Michael's pain. He immediately recommended that the Mianos see Robert Buly, MD, an orthopedic surgeon specializing in hip problems at HSS. "Our doctor said the only place to go was Hospital for Special Surgery," says Mrs. Miano. Justine saw Dr. Buly, as well, and the two-hour trip from Stony Brook was well worth it for the care her children received, Mrs. Miano says.
After a careful consultation, Dr. Buly recommended Michael and Justine get special ultra-high-resolution MRI's and 3-dimensional CT scans at HSS. These diagnostic imaging tools, which show more detail than standard MRI's and CT scans, enabled Dr. Buly to pinpoint the problem and provide a clear diagnosis.
Justine and Michael both had a condition called "femoro-acetabular impingement" or "hip impingement," a mechanical disorder of the hip that tends to run in families. Michael also had hip "dysplasia." The Mianos were relieved to finally have a diagnosis, even though surgery would be needed.
"The goal of the operations was to relieve their pain and allow them to gain normal functioning of their hip joints," Dr. Buly said. "Another important goal of the surgery was to preserve the hips as long as possible, thus avoiding a hip replacement at a young age."
The hip is a ball-and-socket joint: the ball-shaped head of the femur (thigh) bone fits inside a cup-shaped socket in the pelvis. In a healthy hip joint, the ball rotates freely in the cup, allowing for smooth movement and stability. Cartilage, a protective tissue, lines the bones and limits friction between the surfaces during movement.
Impingement results when the joint is not operating properly. Because of an anatomical abnormality, normal hip motion is blocked or restricted. This causes damage to the rim of the socket and the cartilage, and can lead to hip arthritis at a young age. In the case of the Mianos, the condition caused pain, instability and torn cartilage in their hips.
Dysplasia refers to an abnormality in the shape of the hip joint that is present at birth or develops in early childhood. In Michael's case, the ball on top of the thighbone was not held firmly in the socket because it was too shallow.
"It is not uncommon for doctors to misdiagnosis these problems as 'growing pains,'" says Dr. Buly. "It's important that any young person with persistent hip pain be properly diagnosed and treated. Left untreated, impingement and dysplasia can lead to early arthritis and necessitate a total hip replacement."
The Mianos had surgery on the same day at HSS and were in private rooms next door to each other. Justine's thigh bone was not positioned correctly in the hip socket. To fix the problem, Dr. Buly performed an operation called an osteotomy, in which he surgically reshaped her femur and repositioned it to restore a more normal anatomy. This would allow for normal hip motion and alleviate the impingement. Dr. Buly performed a minimally invasive osteotomy, that is, using small incisions. A rod was placed inside Justine's femur bone for stabilization.
Michael had a somewhat different problem. "He had a condition called 'cam impingement' in which he had a bony bump on the head-neck junction of the upper thigh bone inside the hip joint," Dr. Buly says. There was inadequate space for Michael's hip bone to move freely in the socket.
"Historically, the operation to fix this problem has been done, and often still is in many places, with a large open procedure that is often more invasive than a hip replacement," Dr. Buly explains. "We devised a technique to trim the bone arthroscopically through three tiny incisions, rather than doing a larger open procedure. This allowed for a much faster and less painful recovery."
Both Michael and Justine spent four days in the hospital, followed by physical therapy. Michael went back to college within two weeks and was soon able to resume bike riding, swimming and walking for exercise. He continues to improve and looks forward to getting back to other sports. Justine, who had a more extensive operation, is also making good progress and has an excellent prognosis, according to Dr. Buly.
"It was a very favorable experience; we were very well taken care of," Michael says. "The hospital isn't close to where we live on Long Island, but I would have gone there even if I lived in California."
Mrs. Miano says the staff was extremely helpful, educating the family on what they needed to know. "Everyone at the hospital was wonderful -- very accommodating, polite and attentive. I'm very happy they had the surgery there," she says. "I only wish more doctors recognized this hip problem in young people and didn't dismiss it as growing pains."