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A Focus on Hip Preservation for Children with Hip Disorders

Real. Hip.

When it comes to kids and their hips, there's nothing like the real thing.

"Hip replacement or reconstruction is rarely our first choice when it comes to children or teens," says UW Health orthopedic surgeon James McCarthy, MD. "A reconstructed or replaced hip doesn't keep up with a child's normal wear and tear. Our focus is on preservation, and we have all the tools we need to do that."

Dr. McCarthy and his colleagues in orthopedics and rehabilitation have developed a collaborative set of services designed to diagnose and treat pediatric hip disorders. Their focus is on the hip itself, rather than a specific hip procedure, which allows for a wider range of options based on the patient's needs.

"We offer everything from nonsurgical therapy to hip arthroscopy and corrective osteotomies, if needed," Dr. McCarthy says. "If necessary, we also have access to excellent surgeons who specialize in hip reconstruction."

Hip disorders are common in children. About one in 100 infants (mostly girls) are born with a mild form of dysplasia that usually self-corrects within the first six weeks. About 10 percent of youngsters continue to have hip problems past six weeks and require treatment such as a Pavlik harness for infants or open reductions and casting for older children.

Dr. McCarthy also sees children with osteonecrosis of the hip, known as Legg-Calvé Perthes Disease (LCPD), which occurs when the blood supply to the capital femoral epiphysis is interrupted and causes bone death. LCPD affects roughly one in 1,200 children under the age of 15. Older children may experience "slips," or slipped capital femoral epiphysis, when the failure of the cartilaginous growth plates allows the epiphysis to slip on the femoral neck. Slips may occur after a sports injury, but also for other unknown reasons.

"Hip disorders are difficult to diagnose in children, because they often present as pain in the thigh or knee," Dr. McCarthy says. "Vague anterior thigh, knee or groin pain should be a red flag to examine the hips as well."

The focus on preserving the natural hip has led to new directions in clinical and translational research. For example, to preserve a child's normal development as much as possible, researchers are examining whether gently guiding growth plates might correct the disorder as the child grows.

"Guided growth could be especially helpful to children with neuromuscular programs, like cerebral palsy." Dr. McCarthy says.

UW Health's pediatric hip services have drawn a smaller subset of patients who may feel a little out of place in the barnyard-decorated halls of the American Family Children's Hospital.

"We also see a number of adults in their 20s and 30s with congenital or childhood-onset pediatric hip disorder that still requires attention," Dr. McCarthy says. "A person may turn 18, but his or her hip disorder may not become 'adult.' Our experience with these particular patterns makes us an ideal resource for adults as well. So, 24 months or 24 years, we serve them all."

To learn more about pediatric hip services at UW Health, call (608) 263-6420.