Orthopedic Surgery

Young Adult Hip Preservation Program

The Young Adult Hip Preservation Program at The Children’s Hospital of Philadelphia is a unique program specifically for young adults with complex hip disorders. Left untreated, these often-painful conditions can lead to early hip replacements in otherwise active and healthy individuals.

Unlike most programs at CHOP — which are tailored to younger children and their families — the Young Adult Hip Preservation Program is designed to meet the needs of young adults (age 18 to mid-30s) who are active participants in their own healthcare decisions.

Whether you recently began experiencing hip pain or are experiencing residual effects of a childhood hip disorder, our specially-trained hip experts have the skills, knowledge and experience to help you get back on your feet and resume your busy lifestyle.

Each year, we examine hundreds of teens and young adults with congenital, developmental and post-traumatic hip disorders. Some require complex, specialized surgeries — only available at CHOP and select facilities across the country — to preserve, adjust or restore their natural hip function.

I'm a young adult, why would I come to CHOP?

Why should you choose CHOP’s Young Adult Hip Preservation Program instead of an adult provider? Because we are national experts in treating hip disorders that you may have been born with or developed during childhood.

For some people, your hip disorder doesn't become problematic or painful until adulthood — but it often stems from an underlying pediatric hip condition. The pathology and treatment for these congenital, pediatric disorders requires the knowledge and expertise of doctors who, like those at CHOP, understand the full developmental spectrum of the human hip joint. 

Furthermore, we are not looking to replace your natural hip with an artificial one — as most adult providers are — but rather to reconstruct or enhance your natural hip and hip socket. Hip preservation and reconstruction prolong the function of your natural hip and decrease the need for an artificial hip replacement now and in the future.

CHOP's Young Adult Hip Preservation Program has the experience, expertise and comprehensive care to change your life for the better.

Our experience

CHOP’s Young Adult Hip Preservation Program is the largest and most comprehensive program in the region for adolescents and young adults with hip pain. 

Our surgeons — Wudbhav N. Sankar, MD, and Lawrence Wells, MD, — perform some of the most complex orthopedic surgical procedures in the world.

We have special expertise in hip preservation in adolescents and young adults to stop continued damage to bone and cartilage. By fixing your natural hip, our doctors can prevent the need for premature replacement with an artificial hip. Dr. Sankar has extensive specialized training in hip reconstruction for young adults and is the only physician in the region performing certain highly-complex hip preservation surgeries on both adolescents and young adults.

Our expertise

Our team of hip specialists is actively researching the conditions that cause hip deformities, investigating new surgical techniques, and tracking long-term outcomes for patients with hip disorders.

Dr. Sankar, director of CHOP’s Young Adult Hip Preservation Program, is an integral member of three major pediatric and young adult multi-center research groups, including the International Hip Dysplasia Institute (IHDI), the International Perthes Study Group (IPSG), and the Academic Network of Conservational Hip Outcomes Research (ANCHOR). 

Current hip research in young adults includes examining surgical outcomes for Ganz periacetabular osteotomy, hip arthroscopysurgical dislocation of the hip and developing novel imaging techniques for avascular necrosis and early osteoarthritis. 

In addition, our hip specialists regularly collaborate with the Center for Applied Genomics at CHOP, one of the world's largest genetics research programs and the only center at a pediatric hospital to have large-scale access to state-of-the-art throughput genotyping technology.

Our comprehensive care

The Young Adult Hip Preservation Program offers complete care for young adults with hip defects or injuries — from evaluation, to treatment and long-term follow-up care.

We offer a full spectrum of diagnostic and imaging testing (MRI, CT scans and X-rays), and also use individualized, disease-specific imaging protocols that include cartilage mapping technology. By better visualizing the entire hip, our clinical team can provide a more accurate diagnosis and help guide surgical treatment if needed.

Hip conditions that affect young adults

The Young Adult Hip Preservation Program offers comprehensive evaluation, testing and treatment for hip conditions that affect older teens and adults in their 20s and 30s which, in many cases, are best treated by experts who have experience with the potentially underlying pediatric hip condition.

Acetabular dysplasia

Acetabular dysplasia is an abnormally shallow hip socket that leads to uncovering of the femoral head and excessive pressure on the rim of the hip socket. This can be painful — especially if you are active. 

Acetabular dysplasia can be a continuation of developmental dysplasia of the hip (DDH), which is often discovered in early childhood.

In some cases — where a child doesn’t display any symptoms or only has mild DDH — the condition goes undiagnosed until adolescence or later. During or after puberty, active young people may experience hip pain and are then diagnosed with acetabular dysplasia.

Treatments may include non-surgical options such as physical therapy, weight loss and activity restriction. If surgery is needed to treat your hip dysplasia, our expert hip surgeons generally recommend a Ganz periacetabular osteotomy to improve the coverage of the hip joint, relieve pain and allow you to resume an active lifestyle.

Femoroacetabular impingement

Femoroacetabular impingement (FAI) is a condition where the femoral head and the hip socket don't match appropriately, which can lead to premature contact between these two structures with hip range of motion. Over time, this repeated contact can cause damage to the labrum (O-ring type structure which surrounds the hip socket) or the underlying cartilage. 

Some people with FAI can live active lives and never experience pain or hip problems. Others, especially athletic and active people, may work the hip joint more and experience pain earlier than those who are less active.

Treatment may include non-surgical options such as physical therapy, injections and anti-inflammatory medications, or surgery. Many people with FAI can be successfully treated with surgical dislocation of the hip or hip arthroscopy

Cartilage tears in the hip

Tears of the labrum — the O-ring type elastic tissue that surrounds the ball-and-socket hip joint — and articular cartilage in the hip can cause pain, stiffness or a locking and clicking sensation in your hip joint. It can also limit the range of motion in your hip joint. Athletes who participate in sports like football, soccer, ice hockey and ballet are at higher risk for cartilage tears in the hip.

Treatment for cartilage tears may include pain medication, injections, physical therapy and surgery. Many hip cartilage tears can be treated with arthroscopic surgery. Cartilage tears are often associated with femoracetabular impingement and treatment may be targeted at relieving both conditions.

Continuation of pediatric hip disorders

We also examine and treat young adults with new or lingering effects of childhood hip disorders including:

Scheduling an appointment

To schedule an appointment with the Young Adult Hip Preservation Program, call 215-590-1527.

Be prepared to share basic information about your medical history, symptoms and insurance. If a referral is required, request one from your primary care provider.

Many young adult hip patients come to CHOP’s Main Campus in Philadelphia for their initial assessment; but we also see adults at the CHOP Specialty Care at Virtua, in Voorhees, NJ, and at CHOP Specialty Care Center in King of Prussia, PA

To help us better understand your history of hip problems, please download and print a copy of the New Patient Form, and bring it to your appointment.

About your visit

When you arrive for your appointment, please register with our staff at the front desk. You may find yourself in a waiting room with a lot of younger patients and their families, but don't worry. Our staff is very familiar with older patients coming to CHOP for hip evaluations.

When your name is called, you will be escorted to a private examination room. Our clinical team will assess your vital signs, review any medications you are taking, and discuss the reason for your visit.

Our goal for this initial visit is to better understand the cause of your pain; what therapies you’ve tried in the past and what surgeries you’ve had, if any.

Our hip specialists will complete a thorough physical exam and review any X-rays or other imaging you’ve brought with you. If you do not have current imaging studies, you will be referred to our on-site expert radiologists who can perform X-rays the same day as your appointment.

State-of-the-art imaging

Imaging helps our doctors better understand what’s going on deep inside your hip socket. Depending on your symptoms, condition and X-rays, we may recommend specialized advanced imaging studies, which are all available at CHOP:

Hip pain treatment options

At the Young Adult Hip Preservation Program, we offer a range of non-surgical and surgical treatments for young adults with hip pain. Your doctor will discuss your options and recommend a treatment plan. The final treatment decision will be yours to make.

Non-surgical treatments

When treating hip pain, non-surgical treatments should always be considered first. In some cases, conservative treatments such as rest, activity restriction, physical therapy, and/or pain medication can resolve the pain and swelling. 

It's important to consult a physician if you are experiencing hip pain. After a physical exam, your doctor may prescribe one of the following non-surgical treatments.

Anti-inflammatory (pain) medication

Non-steroid anti-inflammatory medicines are used to treat mild to moderate hip pain and swelling from conditions such as muscular or cartilage tears, tendonitis, arthritis or synovitis. These medications may also be used in conjunction with physical therapy, or as part of the recovery plan after surgery.

Physical therapy

Physical therapy is a vital part of CHOP's Young Adult Hip Preservation Program. The hip joint is made up of about 30 different muscles; some quite deep in the body. Physical therapy strengthens these muscles, increases flexibility and range of motion, and can decrease swelling and inflammation. In many cases, physical therapy can eliminate the need for hip surgery. 

In cases where surgery is inevitable, pre-operative physical therapy can optimize your strength and conditioning in preparation for the procedure. After surgery, post-operative physical therapy is an important component in recovery and can help you resume daily activities. 

Ultrasound-guided injections

Injections are commonly used to relieve hip pain, and help diagnose the cause of the pain.  At CHOP, nonoperative sports medicine specialist Naomi J. Brown, MD, administers ultrasound-guided injections to diagnose and treat young adults with hip disorders. 

For diagnostic procedures, our team uses dedicated high-resolution ultrasound equipment to guide injections of a local anesthetic directly into a tendon, bursa, or the hip joint itself. Based on a patient's response to the injection, we may be better able to pinpoint the source of the pain. In addition to providing crucial diagnostic information, injections can provide a therapeutic effect resulting in potentially extended periods of pain relief.

Injections are also an important adjunct to physical therapy. By providing temporary pain relief, injections may provide a "window of opportunity" to maximize gains from therapy.

Surgical treatments

If your hip pain or discomfort is caused by an abnormality of the hip joint or hip cartilage problems, our doctors may recommend one of the following specialized surgical options.

Ganz periacetabular osteotomy (PAO)

Considered the gold standard in surgical correction of acetabular dysplasia, the Ganz periacetabular osteotomy (PAO) preserves a shallow hip joint instead of replacing it with an artificial one. In the procedure, the surgeon reorients the hip socket (acetabulum) to provide more coverage over the ball (femoral head), therby relieving the excessive pressure around the rim of the hip socket.

The goal of PAO is to eliminate or decrease pain, restore function and maximize the functional life of the hip. After surgery and sufficient recovery, you can return to an active lifestyle. This surgery delays — and in many cases eliminates — the need for an artificial hip replacement later in life.

Surgical dislocation of the hip

Surgical dislocation of the hip is a highly specialized procedure in which the hip is carefully taken out of the socket to provide 360-degree access to both the acetabulum (hip socket) and the femoral head (ball joint at the top of the hip bone).

With a wide viewing angle, the surgeon can fully examine the labrum and articular surfaces, and perform therapeutic treatments such as bone shaving for impingement relief, major reshaping of the femoral head, and osteoarticular cartilage grafting.

For patients with unexplained hip pain, surgical dislocation of the hip may offer new insight into the cause of the pain and suggest additional treatment options, such as local cartilage transfers.

Hip arthroscopy

Arthroscopic surgery is a less invasive surgical technique to treat some problems inside the hip, such as labral tears. Arthroscopic surgery uses small incisions, thin instruments and a small camera called an arthroscope to repair and clear out any damage to the hip cartilage, trim the bony rim of the acetabulum (hip socket), and/or shave down the bump on the femoral head (ball joint at the top of the hip bone).

Autologous bone-marrow grafting and core decompression for avascular necrosis

This procedure is used when the blood supply to the hip joint is interrupted and the bone begins to die (avascular necrosis). First, the surgeon drills a hole into the bone to relieve the internal bone pressure (core decompression), then injects healthy bone marrow harvested from another part of the patient’s body (autologous bone-marrow grafting) into the diseased hip bone to faciliate healing.

Free vascularized fibular grafting

In mild-to-moderate avascular necrosis, treatment is generally core decompression and bone grafting; in late-stage avascular necrosis, the standard treatment is total hip arthroplasty. Microsurgical free vascularized fibular grafting (FVFG) is an alternative approach to treat certain forms of avascular necrosis.

In a FVFG procedure, dead bone at the hip is replaced with live, structurally sound and vascularized bone from the fibula (lower leg). Blood vessels from the living bone are then attached to those around the hip to provide immediate blood supply. 

FVFG is offered in cooperation with our orthopedic colleagues at the Hospital of the University of Pennsylvania (HUP).

Meet our team

Program director
Orthopedic surgeons
Nonoperative sports medicine physicians
Nurse practitioner
Registered nurse
HUP-affiliated orthopedic faculty 

Contact us

For more information or to schedule an appointment, call 215-590-1527 or contact us online

Reviewed by: Wudbhav N. Sankar, MD
Date: March 2014

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