Significance of Pediatric Hip Preservation

Introduction

Hip preservation involves both nonsurgical and surgical approaches that are aimed at safeguarding a deteriorating hip joint to postpone or avoid surgery like joint replacement surgeries. Hip preservation treatment focuses on alleviating symptoms and addressing abnormalities in hip joint development that may manifest during adolescence or childhood. Symptoms such as hip pain or weakness may prompt investigation, although the exact cause of abnormal hip joint development is unclear.

What Conditions Require a Hip Preservation Approach?

Children with the following conditions can benefit from hip preservation surgery:

1. Developmental Hip Dislocation: Developmental hip dislocation refers to the displacement of the femur's ball, situated on top of the thigh bone, from its normal position within the hip socket. This deformity can typically be corrected through the use of bracing or surgical intervention.

2. Developmental Dysplasia of the Hip (DDH): In children and infants with DDH, the hip joint sometimes fails to form properly, which results in a shallow socket where the femur’s ball may become loosely positioned.

3. Adolescent Hip Dysplasia (AHD): Hip dysplasia is a condition in which there is misalignment or improper fitting of the ball and socket joints within the hip of the affected individual. AHD typically stems from untreated or undetected developmental hip dysplasia, with symptoms not evident until adolescence. A baby with hip dysplasia may not exhibit any symptoms even in cases of aggressive hip dysplasia. Such instances occur as a result of rapid growth spurt, increased weight-bearing demands as the child grows older, or increased activity. Surgical intervention or physical therapy can be preferred treatment methods. It can occur in firstborn children, females, children with breech presentation at birth, close relatives of already affected patients, individuals with neuromuscular disorders, and individuals with Down’s syndrome.

4. Femoro-acetabular Impingement: This condition can occur when there is improper contact between the acetabulum’s rim and the femur’s neck, possibly due to excess bone growth on one or both sides of the hip joint components.

5. Slipped Capital Femoral Epiphysis (SCFE): Slipped capital femoral epiphysis is a condition commonly occurring during the growth spurts of preteens and teenagers. It is characterized by the slipping of the ball of the hip from the femur bone, causing pain and hip deformity. Surgical intervention might be necessary to prevent further displacement.

What Are Hip Preservation Treatments and Procedures?

1. Non-surgical Approach: In certain clinical scenarios, hip surgery will not always be necessary. If the joints are stable enough to recover without the risk of displacement, resting for a certain duration can aid in natural healing. Additionally, individuals may utilize crutches or cane to lessen pressure on the affected joint during the healing period. Other non-surgical approaches that may be suitable for the children include:

• Activity Modification: Activity modification can be a little challenging in the pediatric population. Restraining the children from doing certain activities can help in accelerated healing. Supportive footwear and restraints can be used by the children to prevent movement.

• Physical Therapy: Physical therapy has a vital role in strengthening hip muscles, thereby promoting flexibility, and expanding the range of motion. Additionally, it can also effectively decrease swelling and inflammation. In most instances, physical therapy has the potential to eliminate the necessity for hip surgery.

• Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are useful in alleviating mild to moderate hip pain and swelling arising due to many disorders such as tendonitis, muscular or cartilage tears, arthritis, or synovitis. These medications are prescribed independently or along with physical therapy, even during the post-surgery recovery regimen.

• Diagnostic or Therapeutic Injections: Injections are used to alleviate hip pain and help in diagnosing the underlying cause. For diagnostic purposes, high-resolution ultrasound-guided injections are used. It also helps in targeting specific injections to the bursae, tendons, or hip joints itself. In addition to diagnostic benefits, it also offers therapeutic benefits to the patient. It can be given as an adjunct to physical therapy.

2. Surgical Approach: If conservative approaches for treating hip conditions fail, hip preservation surgery may be necessary. The main goal of surgical correction is to correct the soft tissue damage and repair any ill-positioned bones that are preventing proper joint function. In children, most hip conditions are treated surgically using one of the following techniques:

• Internal Fixation: In this procedure, screws, metal plates, or pins are used to stabilize displaced bones, which helps in proper healing too. Mostly, these fixation devices remain in the body after the healing process.

• Arthroscopy: Arthroscopy includes the insertion of an arthroscope (a small camera), through a minor incision to visualize the injured area. With this visualization, the surgeon can be able to address damaged tissue, promoting optimal joint healing. Arthroscopic surgery procedures can include labial refixation (trimming the torn tissue around the acetabular rim and reattaching the labrum to the bone), labial reconstruction (replacing a damaged labrum with tendon graft if it is unrepairable), and debridement (removing weak or torn labral tissue to reduce pain).

• Osteotomy: Osteotomy helps in realigning joint bones to distribute the weight evenly on normal joint cartilage. This helps in reducing stress on the joint, which will minimize symptoms and further damage due to disease progression. Periacetabular osteotomy (PAO) is one of the most common surgeries for adolescents and young adults with hip dysplasia that involves the repositioning of the acetabulum to make the appropriate alignment. Arthroscopy can also be performed concurrently with PAO.

Conclusion

Advanced imaging technologies and innovative surgical approaches have aided in improving the quality of life of patients with debilitating disorders. Hip preservation is indispensable in the pediatric population. The latest non-surgical and surgical approaches have enhanced faster healing and overcome the limitations of the affected individuals. Non-operative treatments, rehabilitative procedures, and surgical techniques altogether can help in addressing the constraints caused by many hip disorders. Therefore, it is important to be aware of the latest diagnostic methods and treatment protocols for orthopedic problems.