Pediatric Hip Preservation

There are several potential conditions that can lead to hip degeneration and pain. These include atypical anatomy in and around the hip joint, which can be congenital, developmental or traumatic in origin. Strains and sprains of the muscles and ligaments around the hip may also cause hip joint pain. A short list of potential hip conditions includes:

• Avascular Necrosis (AVN)
• Bursitis
• Hip Dysplasia
• Hip Impingement
• Hip Torsion/Rotation Abnormalities
• Labrum Tear
• Legg-Calvé-Perthes Disease
• Osteoarthritis
• Slipped Capital Femoral Epiphysis (SCFE)
• Snapping Hip
• Synovitis

The primary symptom in hip joint disorders is pain. Most often, this pain is primarily in the front of the hip, though it can be on the side or back of the hip. The pain is typically worse with activities and certain hip positions that exacerbate the underlying hip irritation. Pain symptoms often begin in adolescence or young adulthood, though can happen at any age.

The diagnosis of any hip condition begins with a history and physical examination performed by a healthcare provider. Imaging is often required as part of the diagnostic evaluation as many different hip conditions can present in a very similar manner. The first imaging obtained will be x-rays. If surgical treatment is recommended, advanced imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) will likely be obtained for enhanced three dimensional understanding of the hip joint and surrounding tissues.

If someone has hip pain that is significant and/or not transient in nature, contacting their primary care physician for evaluation is important.

The management of hip pain typically begins with non-invasive treatments. These include use of physical therapy and medicines such as anti-inflammatories. Often hip pain will resolve with these approaches. If hip pain remains unresolved, your physician may recommend an intra-articular injection of medication, which can be used both for pain relief and for diagnostic evaluation.

If the hip pain continues despite these measures, surgical treatment may be necessary. Several surgical options are available. The specific technique recommended will depend upon the underlying hip condition being treated. Potential surgical techniques include the periacetabular osteotomy (PAO), surgical hip dislocation and hip arthroscopy.

The PAO is a technique that allows the surgeon to re-orient the hip joint to provide a more appropriate relationship between the two sides of the hip joint. It is most often used to treat hip dysplasia, though it may be recommended for other hip conditions, such as Legg-Calvé-Perthes disease and hip impingement.

The surgical hip dislocation is a technique that allows the surgeon to see the entire hip joint. It is most often used in the treatment of hip impingement. It can also be used in the treatment of slipped capital femoral epiphysis (SCFE), Legg-Calvé-Perthes disease and avascular necrosis (AVN).

Hip arthroscopy is a minimally invasive surgical technique that allows the surgeon the access the hip joint through small incisions. These small incisions are used to insert a camera and multiple instruments into the hip joint, allowing the surgeon to address the underlying hip condition. This technique is most often used in the treatment of hip impingement.

The specific prognosis for the hip depends largely on what hip condition is causing symptoms and how long the process has been present. Often, if the condition is treated early and minimal hip degeneration is present, the outlook can be excellent.