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Hip disorders and treatment

Hip disorders and treatment

Hip disorders and treatment

We believe each child deserves an individualized treatment plan that utilizes the most advanced and innovative techniques. Our focus is early detection and customized treatment that is as noninvasive as possible.

Shriners Hospitals for Children — Salt Lake City has a team of highly trained professionals who specialize in pediatric conditions of the hip. Kristen Carroll, M.D., and Theresa Hennessey, M.D., both specialize in developmental dysplasia of the hip, Legg-Calve-Perthes disease and hip preservation. Marcella Woiczek, M.D., has a research concentration in lower extremity deformities and a special interest in hip pathology and hip preservation, particularly related to developmental dysplasia of the hip, Legg-Calve-Perthes disease and slipped capital femoral epiphysis.

Conditions treated

We treat the following conditions:

  • Adolescent hip preservation
  • An inflammatory reaction, such as transient or toxic synovitis.
  • Developmental dysplasia of the hip (DDH)
  • Infection in the joint (septic arthritis), the bursa (septic bursitis) or the hip, or pelvic bone (osteomyelitis)
  • Juvenile idiopathic arthritis (JIA)
  • Legg-Calve-Perthes disease
  • Neuromuscular hip abnormalities
  • Slipped capital femoral epiphysis (SCFE) An inward twisting of the thighbone (femoral anteversion)

Overview of specific diagnoses

Developmental dysplasia of the hip

Nonsurgical treatment
These methods are most common when a baby is less than 6 months of age. They typically consist of bracing a baby in such a way so that his or her hips are kept in a better position for hip joint development. The goal is to influence the natural growth processes of the baby so a more stable hip joint is developed.

  • Hip abduction brace is a brace that can be used for infants to hold their hips in a properly aligned position to encourage normal hip joint development. Also called fixed-abduction braces, they hold the legs apart and are not flexible like the Pavlik harness.
  • Pavlik harness is a specially designed harness to gently position your baby's hips in a well aligned and secure position. This better positioning encourages normal hip joint development over time.

Surgical intervention
If the hip stays in the joint and a complication known as avascular necrosis (AVN) does not happen, then the bones will look completely normal a couple of years after surgery. After most surgical procedures a spica (body) cast is used to keep the hip aligned in the new, corrected position while the tissues around the hip joint heal and reform into a proper hip joint.

  • Closed reduction is the most common treatment between the ages of 6 and 24 months of age. This is a minimally invasive procedure where the physician physically manipulates the ball of the hip back into the socket. This is done with the child under general anesthesia and involves a body cast to hold the hip in place for a few months.
  • Femoral osteotomy is done when the upper end of the thighbone needs to be tipped so the ball points deeper into the socket. This is sometimes called a varus de-rotational osteotomy (VDO or VDRO).
  • Open reduction is done when it is suspected that tissue is keeping the head of the femur (the ball at the top of the thigh bone) from going back into the acetabulum (the socket). In young children, clearing out the hip joint may be all that's needed. In older children, the ligaments of the hip also need to be repaired.
  • Pelvic osteotomy is done when the hip socket needs repair. There are several different types of pelvic osteotomies and the choice depends on the particular shape of the socket needing repair, the child's age and the surgeon's experience.

Legg-Calve Perthes

The goal of treatment for Legg-Calve-Perthes is to keep the femoral head as round as possible. Surgery usually is not needed for children younger than age 6. They still have a lot of growing left to do so the femoral head has more time to repair the damage caused by this condition. Younger children tend to heal well with conservative treatments.

Therapy
If your child is younger than 6, it is often recommended to observe and implement symptomatic treatment with stretching, limited running and jumping, and medications as needed.

Other nonsurgical treatments include:

  • Braces: Braces are sometimes used to hold the hip in a healthy position so it can heal appropriately. Bracing also can help modify activity.
  • Casts: To keep the femoral head deep within its socket, your doctor may recommend a special type of leg cast that keeps both legs spread widely apart for four to six weeks. After this, a nighttime brace is sometimes used to maintain hip flexibility.
  • Crutches: In some cases, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint.
  • Physical therapy: As the hip stiffens, the muscles and ligaments around it may shorten. Stretching exercises can help keep the hip more flexible and keep the hip in the socket.

Surgery
Most of the orthopaedic treatments for Legg-Calve-Perthes disease are aimed at improving the shape of the hip joint to prevent arthritis later in life.

  • Contracture release: Children who have Legg-Calve-Perthes often prefer to hold their leg across the body. This tends to shorten nearby muscles and tendons, which may cause the hip to pull inward (contracture). Surgery to lengthen these tissues may help restore the hip's flexibility.
  • Hip preservation involves reconstructive surgery of the skeletally mature hip to improve longevity of the natural joint before hip replacement.
  • Joint realignment: For children older than age 8, realignment of the joint has been shown to restore a more normal shape to the hip joint. This involves making surgical cuts in the femur or pelvis to realign the joints. The bones are held in place with a plate while the bone heals.
  • Joint replacement: Children who have had Legg-Calve-Perthes sometimes require hip replacement surgery later in life. These surgeries can be complicated because of a higher risk of bone fracture and nerve damage.
  • Removal of excess bone or loose bodies. In older children with painful, restricted motion, trimming extra bone around the femoral head or repairing damaged cartilage may ease motion and relieve pain. Loose bits of bone or torn flaps of cartilage can be removed.

Slipped capital femoral epiphysis

Slipped capital femoral epiphysis affects the hip joint of teens and preteens. In SCFE, a weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone.

Every hip with SCFE should be surgically treated urgently to prevent the more immediate dangers associated with SCFE.

The majority of children treated for SCFE at Shriners Hospitals for Children — Salt Lake City receive corrections that enable them to walk, play, grow and live active lives. Treating the child's SCFE as soon as symptoms develop greatly increases the likelihood of a successful outcome. However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, patients should continue to be followed by their orthopaedist until they are fully grown.

Neuromuscular hip abnormalities

Spasticity and/or muscle weakness caused by neuromuscular disease can lead to hip deformities similar to developmental dysplasia of the hip. Surgical treatment is indicated if the dysplasia worsens with time or is progressive or painful. The surgical treatments include soft tissue muscle-lengthening and/or femoral or pelvic osteomity as defined above for the treatment of DDH.

Adolescent hip preservation

Adolescent hip reconstruction addresses a specialized group of complex surgical procedures used to treat teenagers and young adults with residual complex hip deformity from conditions like developmental dysplasia of the hip, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, femoroacetabular impingement (FAI), trauma or infection.

   
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