Hip Preservation Program
The Hip Preservation Program at Children's Hospital Los Angeles specializes in diagnosing and treating:
- congenital hip disorders
- developmental hip disorders
- post-traumatic hip abnormality
- sports related hip injury
- adolescent and young-adult hip pain
Specially trained pediatric orthopaedic surgeons use the latest diagnostic techniques, including ultrasound, arthrography, bone scans, computed tomography (CT) and magnetic resonance imaging (MRI), gait analysis, and EOS in their evaluation. Three dimensional analyses assist the orthopaedic surgeon in understanding the source of your hip pain and optimizing treatment.
- Orthopaedic surgeons, specially trained in:
- Hip arthroscopy
- Hip reconstruction
- Total hip replacement
- Physicians’ assistants
- Physical therapists
The hip is a ball and socket joint held together by ligaments and a joint capsule.
The ball is called the “femoral head.” This is the top of the femur (thigh) bone.
The socket is called the “acetabulum” and is part of the pelvis bones.
The femoral head fits into the acetabulum and rotates freely in the socket. The femoral head and the acetabulum are both covered with smooth articular cartilage, which allows the hip to glide freely during motion.
The labrum is made up of a different type of cartilage and runs around the edge of the hip joint. The labrum makes the acetabulum deeper, provides the seal of the hip joint, and helps to stabilize the hip.
Types of Hip Disorders
Our physicians care for children, adolescents and young adults who have hip pain resulting from:
- Developmental Dysplasia of the Hip (DDH)
- Legg-Calve-Perthes Disease
- Slipped Capital Femoral Epiphysis
- Femoroacetabular Impingement
- Avascular Necrosis
- Sports Injuries
“Hip dysplasia” means that the hip joint is the wrong shape or that the acetabulum is not the correct shape or in the correct position to cover the femoral head. Developmental dysplasia of the hip includes a spectrum of abnormalities that can range from a shallow acetabulum all the way to a completely dislocated hip. These can present in patients as young as a few days old or can be silent until adulthood.
A joint that is too shallow or not shaped correctly will place more stress on a smaller area. This will lead the hip joint to wear out faster than one that has a normal shape. Eventually, the hip joint can see too much wear and it will become irreversibly damaged. Treatment for this problem varies based on the patient’s age and the severity of the problem. Infants and young children can often be treated with bracing or casting, while older children, adolescents, and young adults may require surgery for this problem. Surgeries can be performed to move the acetabulum and help prevent the cartilage from wearing out too quickly.
Legg-Calve-Perthes disease is a childhood disorder resulting from loss of blood supply to the femoral head of the hip joint. The loss of blood supply can cause bone necrosis (death) leading to flattening and deformity of the femoral head. A wide range of children (ages of 2 to 15 years) can be affected – most commonly, boys between 4 and 10 years. Pain and limping are common complaints. Age at onset of disease, femoral head shape, and the amount of disease involvement affect the outcome – specifically, the risk of arthritis of the hip joint. Treatment is focused on maintaining the femoral head shape as round as possible and ensuring that the femoral head remains contained in the hip socket. Treatment measures may include rest and limiting activities, physical therapy, bracing, casting or surgery.
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder of adolescents. It typically affects growing children aged 10-15 and occurs when the ball of the hip begins to slip at the growth plate. Symptoms include a limp and gradual onset of hip or knee pain for several weeks or months. This condition is best treated by early diagnosis and surgery to stabilize the slippage and prevent the disabling complications. Reconstructive surgeries may be required to improve the hip motion and function after a SCFE.
Femoroacetabular Impingement is a condition usually affecting young adults and typically results in intermittent groin or hip pain. A misshapen femoral head (ball) and/or acetabulum (socket) causes excessive friction in the hip joint and can result in damage to the cartilage or labrum. The diagnosis can usually be made based on the clinical history, physical findings, and x-rays. CT and/or MRI are helpful if surgery is recommended. Not all patients require surgery. If surgery is necessary, the bone abnormalities can be addressed via hip arthroscopy or open surgery.
Avascular necrosis (AVN, also called osteonecrosis) of the hip can be a painful condition due to death of bone and cartilage cells resulting from disruption of the blood supply. With death and collapse of bone and cartilage tissue, avascular necrosis can ultimately lead to destruction of the hip joint and arthritis. AVN can affect people of all ages. Many times the cause of AVN is unknown, but the risk for AVN may be heightened by trauma, medications (in particular, corticosteroid medications), alcoholism, and other medical conditions (like sickle cell disease, systemic lupus erythematosus, and Crohn’s disease). Treatment can include both nonsurgical and surgical options. Rest and limiting activities, physical therapy, and medications (like bisphosphonates) can help relieve pain. Surgery (in particular, hip preserving procedures) can be effective in the early stages (prior to femoral head collapse).
A hip fracture is a partial or complete break in one of the bones that make up the hip joint, which includes the thigh bone (femur) and socket (acetabulum). X-rays are typically performed, and occasionally further imaging such as an MRI or CT scan may be required to make an accurate diagnosis to plan the correct treatment. Commonly, these injuries can be treated without surgery, but often require surgery to restore normal anatomy and function.
Including juvenile rheumatoid arthritis, septic arthritis or other inflammatory hip conditions.
Hip pain is very common in young athletes. Hip pain can result from overuse, a specific sports or activity-related injury, or from an underlying abnormality in the structure of the hip joint. Common conditions that cause hip pain in young athletes include a strain of a muscle or tendon, irritation of the bone or growth plates around the hip joint, or an injured structure inside the hip joint such as the labrum. Most often, hip pain can be treated with non-surgical treatment options, although occasionally arthroscopic or open surgical treatment recommendations may be given.
Hip Preservation Procedures
The hip preservation team routinely performs complex, cutting edge hip surgerical procedures on children and young adults, including:
- Periacetabular osteotomy (PAO)
- Femoral osteotomy
- Surgical hip dislocations
- Relative femoral neck lengthenings
- Modified Dunn (subcapital realignment)
- Hip arthroscopy
- Total hip arthroplasty
Our team conducts research on a wide variety of topics related to hip preservation including:
- Slipped capital femoral epiphysis
- Developmental dysplasia of the hip
- Legg-Calve-Perthes disease
The Hip Preservation program has made many contributions to the literature and its members have spoken at both national and international conferences on these topics.