CHOP gets hip with new young adult program

When you think of hip problems, you probably first picture an older man or woman who needs a hip replacement, but hip pain and mobility issues can actually start when you are a lot younger, most commonly from shape deformities in the hip joints. That is why Children's Hospital of Philadelphia started their new Young Adult Hip Preservation Program last April.

This new program targets older teens and young adults (twenties and mid-thirties) who might have a congenital, developmental or post-traumatic hip disorder that they might not be aware of. Young adults tend to lead very active lifestyles and so when they start to experience a little hip pain that comes and goes like just after running, they have the tendency to brush it off or try unsuccessfully for treatment.

"There is a need in our community for programs that serve patients who don't fall into the children's category, but who are not really ready for a hip replacement. They tend to fall between the two worlds, said Dr. Wudbhav N. Sankar, a pediatric orthopedic surgeon and head of the new program which focuses on preserving, adjusting or restoring function of the natural hip.

"Given how unique this patient population is, these young adults are often seen by practitioners whom don't have the wide spectrum of knowledge to treat these disorders. It is really important to have a place for them to go to be diagnosed and treated," he said.

Left untreated, these conditions could lead to a hip replacement in an otherwise healthy person. In the United States, almost 50 percent of all hip replacements that are performed are for these complex hip disorders.

"The problem is that the joints can slowly break down over time. However if we address it early, we may be able to prevent the need for a hip replacement later in life," Dr. Sankar explained "Because many of these deformities start as pediatric problems, it seemed fitting that we have this program at a children's hospital, where we already have experience with these disorders."

"A shallow hip socket might be formed by the time a child stops growing at 14, but might not be symptomatic until later. Understanding the development of the hip is an important part of pediatric medicine," he added.

Dr. Sankar is one of the few surgeons in the country who has experience performing complex hip procedures like the Ganz periacetabular osteotomy, surgical dislocation of the hip, and head realignments following slipped epiphyses.

"Unlike most adult hip programs, we have special expertise in hip preservation of adolescents and young adults to stop continued damage to bone and cartilage," he explained.

The most common conditions that Dr. Sankar and his team see include: Acetabular dysplasia, an abnormally shallow hip socket that leads to uncovering of the femoral head and excessive pressure on the rim of the hip socket; Avascular Necrosis where the blood supply to the hip joint is interrupted and the bone begins to die; Femoroacetabular Impingement where the femoral head and the hip socket don't match which leads to damage to the labrum or cartilage; and hip cartilage tears.

For Dr. Sankar, a really crucial part of treatment is getting the right diagnosis, and the way to do that is to get a good patient history and physical. "In 2014, this tends to get lost with all the glitz and glamour of modern technology," he said. "It is important to listen to the patient and get patterns of symptoms. The x-ray doesn't tell us everything we need to know. We need to put the data in the right context of what the patient is telling us."

"With imaging, we need to know what to look for. How does the hip move? What movements bother the patient? We tailor our imaging tests to what comes out in the physical to get the right diagnosis," he added.

Dr. Sankar uses dGEMRIC mapping to evaluate the health of the cartilage, 3D reconstructions to see how the hip is shaped and perfusion techniques to look at how blood flows to the hip.

When treating hip disorders, he says that in general they try not to rush into surgery, but start with more conservative measures like physical therapy and targeted injections under ultrasound. However when the patient doesn't respond well to these treatments, then they will perform surgery to realign the hip joint or improve the mechanics so that the hip functions properly.

"In hip preservation, we might use implants or screws and plates to hold the joints together so they heal properly, but we are not replacing the natural hip for one made of metal or plastic," he said.

CHOP's new young adult hip preservation program hopes to provide solutions to a population that in general doesn't seek healthcare or who are misdiagnosed or underdiagnosed.

Dr. Sankar wants them to know that there are solutions and not just for treating the pain. "It might seem funny for young adults to come to CHOP at 23 or 24, but at end of day once they come through the door and see what we can offer, they quickly realize that it is the program that is important, not the walls."

For more information, visit http://www.chop.edu/centers-programs/young-adult-hip-preservation-program#.VFJT4TTF-30 or to make an appointment, call 215-590-1527.

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