Surgery to preserve hips in young patients on rise
Young patients with hip pain have traditionally found themselves caught halfway between hurting and hip replacement. Unless the damage is obvious and dire, no one's wild about replacing the joint, because artificial joints wear out over time and, eventually, younger patients will require a return trip to the operating room for yet another set of hips.
That's changing. Doctors at a handful of orthopedic centers nationwide are now recognized for their expertise repairing hip abnormalities in order to relieve pain and buy time for the joint.
David Bowling, an assistant professor of biology at the University of Utah, was only 37 when he became such a "tweener." A longtime running enthusiast, he found himself slowing down because of tightness and discomfort. Over time, the pain worsened. It took him months to get a diagnosis, and he didn't like what he heard.
Bowling had femoral-acetabular impingement, which is doctor-speak for when the femoral head has too much bone for the socket, or the socket's turned wrong and the two bones bump and do damage.
Dr. Chris Peters, a surgeon at the U.'s Orthopedic Center, often sees patients like Bowling, who are younger than most people would usually associate with hip replacement, but who are in pain. Many of them, he says, have some element of hip dysplasia, which is often a congenital problem that worsens over time. It may not show up as obvious hip socket or femoral head abnormality. It may be quite subtle, but that doesn't mean it's not painful and hard to live with.
Most of the time, it takes an MRI or contrast CTs to assess the damage to the cartilage, which is a major factor in whether the joint can be salvaged or if it will have to be replaced. Once the cartilage is gone, the hip itself will soon follow.
The emphasis becomes making the hip as normal as possible, whether by reshaping it or by reorienting it. Those were the options they considered for Bowling, before an imaging study by a graduate student using CT and computer modeling helped them decide that chiseling away at the femur's too-thick neck would be better than cutting around the socket, rotating it slightly and reattaching it. Some patients, Peters says, need both types of repair done.
Such hip-saving repairs are not small operations. They have been tried arthroscopically, with limited success, and even then, parts of the procedures are done with larger incisions.
Patients can expect a two to three-hour surgery, two or three days in the hospital and six weeks on crutches, usually followed by a few more months with a cane. Full recovery takes months and hard rehabilitative work.
One of the biggest challenges is diagnosis, Peters says, and the U. is hoping to get an NIH grant to enlarge its efforts to prove novel 3D computational modeling work helps tease out the right diagnosis and treatment approach. Doctoral candidate Andy Anderson and Jeff Weiss in the U. bioengineering lab have joined Peters to enroll patients ages 18-40 who have hip pain or hip dysplasia (but not prior hip surgery) in the study. Information is available by calling 801-587-7028.
Salvaging the hip is a harder recovery than hip replacement, says Peters. "It's slightly more invasive surgery. With hip replacement, which is also a very good procedure, we cut out the diseased part. With hip-preserving surgery, more bone and soft tissue will have to heal."
Peters says his goal is to give younger patients another 10 years of hip function. That's nearly the normal life cycle of a replacement hip, although that's improving, too.
And not everyone will need replacement. "With younger, healthier patients who still have cartilage," says physician assistant Jill Erickson, the repair "can last 20 to 25 years."
The most important part, she says, is the decision-making process that goes into what type of hip-saving surgery will be used.
Initially, Bowling didn't like any of his options, so he flew out of state for arthroscopic hip surgery. It didn't solve the problem for very long. When he went back to Peters, Anderson's imaging made the choice for him: He had the bone pared down for a better fit.
"I saw myself as young," says Bowling, who is now 39, "and I didn't want to go through it. Looking back, I should have done it from the start."
Peters repaired Bowling's other hip last February, and while he's not 100 percent yet, he can ride his bicycle for a few hours, hike, even climb mountains. His beloved running, though, is in the past. Jarring, repetitive motion will further damage his hips and hasten the trip to total hip replacement.
By Lois M. Collins
Deseret Morning News
