Hip Reconstruction

In Infants:

Hip problems are often caused by a condition called developmental dysplasia of the hip. This condition can be more easily treated if identified early with an ultrasound during the first couple of months after birth (see early treatment of DDH). If the condition is caught later, the hip needs to be repositioned either by closed reduction or open reduction procedures (see Hip reduction DDH).

In Children:

Hip problems often seen in children between the ages of 6-10 includes a condition called Legg-Calve-Perthes disease. This is a condition in which the femoral head (hip) loses its blood supply and will then slowly re-vascularize over the next 2-4 years. Children affected by this condition often limp and complain of either knee or hip pain. As the hip dies, the femoral head collapses and causes stiffness and contractures of the muscles around the hip. If the femoral head dies after the age of 10 and no other causes are found to explain the lack of blood supply, it is called adolescent avascular necrosis (AVN).

The main principles of treatment include maintaining the motion of the hip (which can be done through physiotherapy and sometimes surgery – Steroid Injection And Core Decompression) and containing the femoral head (the ball) inside the acetabulum (the socket). If the femoral head (the ball) stays inside the acetabulum (the socket), then it will re-shape overtime and stay rounder. If the hip starts to come out of the socket, surgical intervention is necessary. (see Articulated hip distraction).

In Adolescents and Young Adults:

Unilateral knee pain or hip pain in adolescents should always be suspicious for a condition called Slipped Capital Femoral Epiphysis (SCFE). This condition affects the femoral head at the level of the growth plate where the femoral head slips off the neck. In lay terms, can be described as the ice cream falling off the ice-cream cone. This most often happens in patients between the ages of 10-16 that are overweight but can also happen earlier. The slipping of the head can last months and can feel like a pulled muscle and the child may limp. However, the slip can also happen suddenly and cause immediate pain to the point where the child cannot bear weight. Treatment varies depending on the severity of the slip. (see Pinning in situ and Surgical Hip Dislocation)

Femoral-acetabular impingement is a condition affecting young adults where the shape of the femoral neck or acetabulum (the ball or the socket) are abutting one another causing pain and damage to the hip joint. MRI arthrography is usually required to assess the damage to the hip. Surgical intervention to reshape the femoral neck or the acetabulum or both is sometimes required to prevent further damage and alleviate the symptoms. (see Surgical Hip Dislocation and Hip Arthroscopy)

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