The Problem of Hip Pain in Children and Young Adults
Every day, thousands of children and young adults suffer from pain caused by hip disorders. Traditionally, treatment for hip pain for patients in this age group involved little more than a prescription of activity moderation, anti-inflammatory medicines, and painkillers. At the onset of joint disease, pain typically occurs during or just after physical activity. Over time, however, the pain becomes more frequent and many people may have hip pain even when at rest.
Unfortunately, hip replacement for children and young adults is not an optimal treatment option due to activity restrictions and the limited lifespan of the artificial joint. A patient who gets a hip replacement at a very young age may require multiple hip surgeries over the course of his or her lifetime.
In an effort to address this major orthopaedic health issue, Midwest Orthopaedics at Rush has established the first comprehensive orthopaedic program in the Chicago area specializing in the treatment of acute, chronic, and degenerative hip conditions for these patients.
The goal of the Healthy Hip Program at Midwest Orthopaedics at Rush is to preserve the hip and help patients return to a full, active life. The program is geared toward children and young adults with acquired or early degenerative hip problems, sports injuries, or dysplasia. It offers alternatives to hip replacement to a patient population that suffers from chronic hip pain and bony deformities.
Treatment Options
The Healthy Hip Program combines MOR's top-ranked physicians with emerging technologies to diagnose and treat individuals with chronic and degenerative hip conditions. MOR physicians are experts in the diagnosis and treatment of these problems, which may help patients avoid or postpone total hip replacement.
Hip Arthroscopy
Hip arthroscopy is an expanding technique that allows surgeons to treat a variety of hip joint problems that once required open invasive surgery. Advances in surgical techniques and instrumentation allow us to perform a variety of procedures to repair torn labral cartilage, release contracted joint capsules, and remove bone spurs or malformations that can lead to progressive arthritic wear. The labral cartilage that surrounds the hip socket is similar to the meniscus cartilage of the knee. Labral injuries can occur with a variety of sports and recreational activities that include twisting and rotation.
The surgery is performed using a pencil-sized camera (arthroscope) and miniature instruments that are inserted through small incisions (about one centimeter each). Images of the hip and surrounding area are transmitted through the camera via optic fibers to a television monitor and are used by the surgeon to diagnose and correct the disorder. Candidates for hip arthroscopy include active individuals who have pain associated with labral tears, focal cartilage damage, or hip impingement as a result of bone spurs. Hip arthroscopy is less invasive than traditional surgical procedures and is done on an outpatient basis. Patients have an early and accelerated course of rehabilitation, and a quicker return to full activity.
Pelvic Osteotomy
Pelvic osteotomy is a major surgical procedure that involves reorienting the socket of the hip joint to correct biomechanical problems caused by abnormal development of the hip socket. It is the procedure of choice in young patients with this type of developmental abnormality. The hip socket, or acetabulum, is cut free from the pelvis, and is rotated to provide better coverage of the femoral head. Bone screws are used to maintain the new alignment. This reconstruction has good longevity as healthy joint cartilage in the socket now covers the whole femoral head.
Femoral Head/Acetabular Osteoplasty
Femoroacetabular impingement is caused by a structural deformity either in the femoral head or the acetabulum. This hip-joint deformity causes abnormal contact between the proximal femur and the acetabulum during terminal hip motion and creates unbearable hip pain. The problem usually presents in young adults and can often go undiagnosed for years. Femoral head or acetabular osteoplasty can correct the problem and reduce or eliminate the pain.
This surgery may be performed arthroscopically or with an open surgery depending on the severity and location of the abnormality. In arthroscopic surgery, the hip is pulled apart slightly, the site of impingement is identified and the labrum and acetabular cartilage are assessed for lesions. Lesions may be debrided by a shaver or radio thermal device. Any nonspherical sections of the femoral head or prominent sections of the anterior femoral neck are removed to improve the offset of the neck and increase clearance in the joint. The femoral head or acetabulum is reshaped with the focus on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. If the problem is more severe or in an area that cannot be reached by arthroscopy, the procedure is done with an open surgery where the hip is dislocated to allow removal of the spurs and repair of any torn cartilage. The aim of femoro-acetabular surgery is to improve range of movement and to reduce any unwanted contact in the hip joint.
The Program Faculty includes the following MOR physicians who are leading experts in their specific orthopaedic subspecialty. Together this team of experts will collaborate to provide the highest level of care and expertise to patients seeking alternatives to hip replacement.
Contact the Healthy Hip Physicians
• Charles Bush-Joseph, M.D.
• Jorge O. Galante, M.D.
• Monica Kogan, M.D.
• Shane Nho, M.D.
• Walter Virkus, M.D.
