Childhood Hip Disorders

Associated With Degenerative Hip Disease

DYPLASIAPICTURE

Up to 5% of adults may have a history of a hip disorder during childhood. Certain childhood hip conditions are associated with degenerative hip disease that can benefit from hip replacement surgery. If you've experienced hip issues during childhood such as hip dysplasia, slipped capital femoral epiphysis (SCFE), or Perthes disease, and are now grappling with ongoing hip pain and degeneration, this resource is tailored for you.

Adults currently facing ongoing difficulties from childhood hip disorders can turn to Dr. Alexander McLawhorn in New York, NY, and Stamford, CT, for personalized treatment.

How the Hip Joint Works

The hip joint is where the head of the thigh bone – the femur – meets the socket part of the pelvis bone – the acetabulum. The joint creates a ball and socket, where the ball is the head of the femur. Articular cartilage, which is tough, covers both parts to protect the bones and ensure they move smoothly as you walk.

General Signs of Hip Issues

Some general signs of a hip disorder include hip pain or aches, hearing or feeling the hip click as it moves, hip pain during physical activity, trouble getting out of a vehicle, and the inability to sit through a movie.

Understanding Childhood Hip Disorders:

Hip Dysplasia:

  • Hip dysplasia refers to the abnormal development of the hip joint, where the socket is too shallow to fully cover the ball portion of the upper thighbone (femur).
  • This condition can occur during infancy or childhood and, if left untreated, may lead to chronic hip pain, instability, and eventually degenerative changes within the joint.
  • While early diagnosis and treatment with methods such as bracing or surgical interventions can improve outcomes in children, some individuals may still experience long-term consequences, including degenerative hip disease.

Slipped Capital Femoral Epiphysis (SCFE):

  • SCFE is a condition where the femoral head (the ball-shaped end of the thighbone) slips backward relative to the neck of the femur through the growth plate.
  • It typically affects adolescents during periods of rapid growth, particularly overweight children.
  • SCFE can cause hip pain, limping, and restricted movement. Moreover, it may predispose individuals to early-onset osteoarthritis due to altered hip mechanics, hip impingement, and increased stress on the joint surfaces.

Perthes Disease (Legg-Calvé-Perthes Disease):

  • Perthes disease involves the temporary loss of blood supply to the femoral head, leading to its breakdown and eventual deformation.
  • It primarily affects children aged 4 to 8 years and can result in hip pain, stiffness, and difficulty walking.
  • While many children with Perthes disease eventually recover with proper management, some may develop residual deformities or hip joint abnormalities that predispose them to degenerative changes later in life.

Link to Degenerative Hip Disease:

Ongoing Impact:

  • Childhood hip disorders such as hip dysplasia, SCFE, and Perthes disease can alter the biomechanics and structure of the hip joint, setting the stage for degenerative changes over time.
  • Factors such as abnormal joint alignment, hip impingement, increased stress on specific regions of the hip, and altered gait patterns may accelerate joint wear and tear, leading to the development of degenerative hip disease.

Degenerative Hip Disease:

  • Degenerative hip disease, often referred to as osteoarthritis of the hip, involves the gradual breakdown of the cartilage that cushions the hip joint.
  • Common symptoms include hip pain, stiffness, decreased range of motion, and difficulty performing daily activities.
  • Individuals with a history of childhood hip disorders may be at higher risk of developing degenerative hip disease earlier in life, potentially necessitating interventions such as hip replacement surgery to alleviate symptoms and improve function.

Complexities in Surgical Treatment for Adults with Childhood Hip Disorders:

Anatomical Variations:

  • Adults with a history of childhood hip disorders often present with anatomical abnormalities such as dysplastic acetabulum (shallow hip socket), femoral head deformities, or altered hip joint congruence.
  • Addressing these variations requires meticulous preoperative planning and specialized surgical techniques to optimize implant placement and hip stability.

Soft Tissue Management:

  • Previous surgical interventions or chronic hip pathology may result in altered soft tissue structures around the hip joint, including contracted muscles, ligamentous laxity, or scar tissue.
  • Surgeons must navigate these challenges during the surgical procedure to ensure proper soft tissue balancing and stability, which may involve additional soft tissue releases or repairs.

Bone Deficiency:

  • Childhood hip disorders can lead to bone loss or deformities, particularly in cases of severe dysplasia or advanced Perthes disease.
  • Addressing bone deficiencies may require the use of specialized implants such as custom-made prostheses or augmentative techniques such as bone grafting to restore bone stock and ensure adequate fixation of the implants.

Implant Selection:

  • Standard hip replacement implants may not adequately accommodate the unique anatomical characteristics of individuals with a history of childhood hip disorders.
  • Surgeons may opt for specialized implants designed for dysplastic hips to improve hip stability, optimize range of motion, and extend the longevity of the prosthesis.

Use of Technology in Surgery:

  • Technology for hip replacement surgery for adults with a history of childhood hip disorders improves outcomes for these complex surgeries.
  • Preoperative imaging permits advanced 3D preoperative planning to make sure the sizes, geometries and position of hip replacement components are optimized.
  • Intraoperative robotics or navigation enhance surgical precision and make sure that the preoperative plan is executed exactly.

Rehabilitation Considerations:

  • Rehabilitation following hip replacement in individuals with a history of childhood hip disorders may be more challenging due to preexisting muscle weakness, altered gait patterns, or limited functional mobility.
  • Customized rehabilitation protocols focusing on strengthening hip musculature, improving joint proprioception, and optimizing gait mechanics are essential to ensure optimal recovery and long-term function.

Long-term Monitoring:

  • Patients with a history of childhood hip disorders undergoing hip replacement require vigilant long-term monitoring for potential complications such as implant loosening, wear, or dislocation.
  • Regular follow-up visits with orthopedic specialists and imaging studies are necessary to detect and address any issues early, thereby optimizing the lifespan of the prosthetic hip joint.

In summary, surgical treatment of adults with a history of childhood hip disorders presents unique challenges compared to routine hip replacement for primary osteoarthritis. Specialized surgical techniques, technology, implants, and comprehensive rehabilitation strategies are essential to address anatomical complexities, optimize implant function, and ensure long-term success and patient satisfaction.

Contact Alexander McLawhorn

If you had a childhood hip disorder and need treatment as an adult , contact Dr. Alexander McLawhorn, a hip and knee doctor in New York City and Stamford, CT, for a consultation.

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