Hip Preservation Options for Young Adults

Hip Preservation Options for Young Adults

Stephanie, Patient: I started running when I was in about 7th grade.  I ran middle school track.  I love running.  I run to relieve stress, take time for myself, and think.  It's great to run around Drexel. 

In my freshman year of high school, my first cross country season, I started having hip pain.  It would usually occur in the middle of a race or in the middle of a run.  It would basically feel like someone was stabbing me in the hip and then it would last for hours afterwards. 

I went to an adult sports medicine physician.  They basically told me that I would need to have hip replacement by the time I was 35. You're going to have to deal with this, so you're going to have to deal with the hip pain and if want to run, this is what you're going to have to deal with or you can stop.  That really wasn't something that I wanted for myself, especially because I love to run and I am so active.

The first time that I heard about an alternative to getting a hip replacement or multiple hip replacements throughout my life was when I went to The Children's Hospital of Philadelphia and talked to Dr. Sankar.

Wudbhav Sankar, MD: Hip preservation, as its name implies, is the goal of trying to preserve the body's own hip joint.  A hip replacement is essentially a metal in plastic hip.  It's an artificial hip joint where you're taking out the parts that you were born with and you're putting in artificial ones. 

So, if you've been told that your hip pain is unsolvable and you should live with it until you end up getting a hip replacement, I would tell you that you've got to look at this further.  The Young Adult Hip Preservation Program is a program geared toward patients in their late teens, 20s, and 30s.  They may not think to come to the Children's Hospital, but really this is where we have the expertise and the know-how to be able to treat those problems. 

I think it can be funny sometimes for an adult to come to a children's hospital, but I think Children's Hospital and Children's Hospital nurses, Children's Hospital staff, we love taking care of patients.  We love getting people better.  That feeling is no different if you're 10 years old or if you're 25 years old, or if you're 35 years old.  The reality is, is that we have all the support that we need to take really good care of patients. 

I think what makes CHOP so different is the quality of the people.  I think we have amazing nurses and nurse practitioners.  We have great physical therapists, brilliant radiologists.

Diego Jaramillo, MD, MPH: We have one of the largest volumes of pediatric orthopedic MRI in the country and in the world. 

Wudbhav Sankar, MD: Imaging specifically for the hip has become incredibly complex and has advanced in incredible ways over the last few years.  We have very specific protocols now from an MRI standpoint to look at cartilage mapping, to look at the shape of the hip in three dimensional formats to understand the rotation of the bones.  There's so many different aspects to getting good imaging about the hip that it's just absolutely crucial that you do this at a facility that understands the entire disease process and is able to tailor the imaging modalities appropriately. 

There's obviously a wide variety of hip problems that can occur in this age group, but some of them absolutely are the manifestation of pediatric hip diseases that somebody might have had when they were a youngster or a teenager, and it only kind of becomes symptomatic when they're in their 20s or 30s. 

FAI stands for femoroacetabular impingement.  That's a condition where there's a shape mismatch between the femoral head or the ball and the acetabulum, which is a socket.  There creates a situation where when the hip comes into certain positions like flexed up or rotated in, that the two strike each other and can create a syndrome of pain and potentially damage inside the joint. 

Acetabular dysplasia is a shallow hip socket.  That's kind of a characteristic condition that occurs in women. 

Stephanie first saw me because of hip pain.  She now was no longer able to run at all and she was starting to have pain that extended into her daily life, so just going up stairs, just walking her college campus, which she needed to do. 

We talked a lot about her diagnosis, which for her specifically was acetabular dysplasia.  There are all different forms of surgery that may be needed depending on the patient's particular disease.  She needed to have a periacetabular osteotomy to reposition her shallow hip socket. 

A PAO is a periacetabular osteotomy, which stands for around the hip socket and osteotomy means bone cut.  So all a PAO means is that you're making an osteotomy or a bone cut around the shallow hip socket, which then allows you to move the hip socket wherever you need to, to reposition the hip into a much better physiologic position for that patient. 

Some of the surgeries are very complicated and they require very specific expertise.  More involved procedures like a periacetabular osteotomy might be a six-month recovery period before patients are back to sports, running, and vigorous activities with a few months of needing crutches before that.



Stephanie, Patient: After working really hard in physical therapy I was able to start gradually running.  The same year I had surgery I was training for the Broad Street Run, a 10-mile race in Philadelphia.  It was the hardest thing I've ever done, getting myself from not being able to walk to being able to run 10 miles well. 

But then to cross that finish line and stop running and not be in pain is the most amazing feeling. 

I can't say enough good things about CHOP from the nurses to the receptionists, to physical therapy, to Dr. Sankar, to everybody involved in the surgery and there's a huge team.  It was amazing. 

Wudbhav Sankar, MD: Seeing Stephanie being active is the best feeling as a physician.  It's really what you wake up for in the morning when you come to work.  You just want to make people better.  You want to see that they are doing all the things that they want to do.  It's the best gift that a patient can ever give you when they have their good outcome and they come in with that smile on their face, so it means everything.

Stephanie, Patient: Dr. Sankar changed my life.