Keeping hips young

Artificial hip replacement is a common procedure for older arthritis patients, but for those who are 50 or younger, there is one major concern. The artificial joints only last for a few years and doctors can only replace them once or twice. A unique procedure can buy younger patients time.

According to the American Academy of Orthopaedic Surgeons, developmental dysplasia of the hip (DDH) occurs when the ball on top of the thighbone is not firmly held in the socket. In some cases, the ligaments of the hip joint may be loose and stretched.

Pediatricians screen for DDH at birth. When it is detected that early, it is usually correctable; however, if an infant's hip is not dislocated, the condition may go unnoticed until the child begins walking. When detected this late, treatment is more complicated and uncertain.

Left untreated, DDH can lad to pain and osteoarthritis later in life. It may also lead to a difference in leg lengths or an altered gait and decreased agility. Even with treatment, hip pain may develop later in life. Although it can be present in either hip and in any individual, it tends to run in families and affect the left hip. It is also predominant in girls, first-born children and babies born in the breech position, especially with their feet up by the shoulders.

According to Children's Hospital Boston, DDH occurs once or twice in every 1,000 births. Diagnostic procedures for the abnormality include x-ray, ultrasound and MRI.

Treatment for children with DDH varies by case, but some infants are placed in a Pavlik harness. The harness is used on babies up to four months old and holds the hip in place while allowing the baby to move his or her legs a little. If the hip isn't successfully treated with the harness, traction, casting or surgery may be necessary. Traction uses pulleys, strings, weights and a metal frame attached over or on the baby's bed to stretch the soft tissues around the hip. Surgical positioning is sometimes necessary, followed by a spica cast. A spica cast extends from the nipple line to the legs and is worn for approximately three to six months.

Problems caused by DDH may extend into young adulthood, but may be treated by a procedure called periacetabular osteotomy, also known as Ganz osteotomy.

Femoroacetabular impingement (FAI) occurs when there is a small bump on the femoral head that rubs against the labral, the lining inside the socket. This action, which takes place every time the patient moves the hip, wears out the cartilage and eventually causes pain.

FAI patients often get arthritis as at a young age. The abnormality frequently results from childhood disease such as DDH, Legg-Calve-Perthes or slipped capital femoral ephysis, according to the American Academy of Orthopedic Surgeons.

FAI is also frequently seen in young athletes and causes pain in the hip and groin region. The abnormality may begin at birth, or it may develop during growth. Experts say it is likely a combination of one's genetics and environment.

Like DDH, FAI is diagnosed using X-ray and other types of imaging.

FAI in adults is often treated with open surgical dislocation and greater trochanteric osteotomy. New procedures to treat the condition incude arthroscopy and femoroacetabular osteoplasty.

PRESERVING THE HIP: For young adults with hip pain caused by DDH or FAI, total hip replacement is not a good option for several reasons.

First, replacements don't last forever, so young patients will have to undergo more surgeries to continue living with an artificial hip.

Second, artificial joints can pop out.

Third, the replacement can get infected. Lastly, hip replacement limits the patient's activity level, whereas hip preservation does not.

For DDH patients, relief can come from a hip-preserving procedure called periacetabular osteotomy. The surgery involves making controlled cuts around the pelvis and moving the hip socket around to provide a new area of cartilage. This eases arthritic pain by giving the head of the femur new cartilage to rub against.

FAI patients can find relief in another hip preservation procedure called femoroacetabular osteoplasty. Doctors remove the problematic bump on the head of the femur and reshape the socket to provide the patient with a new area of cartilage and free range of motion. Risks of these types of surgeries include blood vessel and nerve damage, over- or under-rotation of the socket and muscle weakness around the hip. The recovery time can last up to six months.

Thomas Jefferson University Hospital
Rick Cushman, Public Relations

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