Hip replacement surgery provides pain relief and improved function for patients with advanced hip disease, but it’s not a great solution for young people.
“For an adolescent or young adult patient — really for any patient under 50 — a hip replacement is sub-optimal because of activity restrictions and the fact that the synthetic hip joint is likely to wear out with time,” said John C. Clohisy, M.D., assistant professor of orthopaedic surgery.
“A patient who gets a hip replacement at a very young age may require multiple hip surgeries over the course of their lifetime.”
Clohisy is one of a growing number of surgeons interested in preserving the natural hip while correcting defects in the joint.
In an operation that takes two to four hours, Clohisy and his colleagues cut the bones around the hip socket and repositioned them — radically changing the hip’s structure. This technique is called the Bernese Peri-Acetabular Osteotomy.
“Most of these patients have an underlying deformity of the hip socket called hip dysplasia, and many have some degree of osteoarthritis,” Clohisy said. “So as they get older, it’s likely that they may need a hip replacement. Our goal is to surgically delay the progression of osteoarthritis and to prolong the life of their true hip joint.”
According to Clohisy, osteotomy surgery is designed for relatively young, healthy patients. Those with multiple medical problems or advanced arthritis are not good candidates.
Patients don’t need a cast, but they do need to stay in the hospital for several days and walk with crutches for several weeks.
Christopher Mackey didn’t realize he needed hip surgery. For several months, when he pitched a baseball, there was a popping sound coming from his left hip.
At first, there wasn’t really any pain involved, but then his groin muscle started to hurt because it was being aggravated by his hip deformity, the same deformity that caused it to pop.
“One way to explain why these patients don’t get symptoms until they are young adults is that the cartilage in the hip can function in an adverse environment for a long time,” Clohisy said.
“But eventually, just as the tread on a tire will go bad, when a patient has underlying problems, their cartilage begins to wear out over time and treatment becomes necessary,”
Mackey was diagnosed with congenital hip dysplasia. In the past, treatment for disorders like Mackey’s frequently involved little more than restriction of activities, anti-inflammatory medicines and painkillers.
Adolescents with hip disease experienced pain, difficulty getting around and doctor’s orders to stop doing activities that put stress on the hip joint.
These patients were too young for hip replacement surgery and too old for the pediatric procedures used to correct deformities in very young children. Ten to 15 years ago, many young adult patients did not even get definitive treatment for their hip problems.
After osteotomy surgery, many patients have returned to cycling, swimming, hiking, golf, tennis and baseball. Some have even returned to high-level competition. However, Clohisy discourages them from taking up repetitive-impact activities.
Clohisy and Perry L. Schoenecker, M.D., professor of orthopaedic surgery and chief of pediatric orthopaedics at St. Louis Children’s Hospital and Shriners Hospital, operated on Mackey’s left hip on Feb. 14, 2003.
Now Mackey can look forward to doing many things he would not be able to do without surgery. He plans to pitch next spring for Southwest Missouri State, where he earned a baseball scholarship.
“With advances in the surgical technique, we can give patients a hip joint that is very functional and can allow them to be active and to enjoy several healthy years of life,” Clohisy said.
“Most patients experience major relief and have very little, if any, hip pain after the operation.”