Treating Hip Problems Less Invasively

Kelsie Hall of Henderson, Md., first felt her hip catch, crack in pain and make a popping noise at age 11. Her pediatrician attributed the symptoms to tight ligaments and tendons that needed to stretch and catch up with her growth, and prescribed physical therapy. But Kelsie’s symptoms continued with increasing pain, and, worse, her hip began to give out.

"There were a couple of times where she just fell on the kitchen floor," says Kelsie’s mother, Kristie Hall.

That’s when Kelsie, now 14, was referred to Hopkins Children’s orthopedic clinic. There, MRIs showed she was suffering from a shallow hip, in which the ball-like head of the femur, or thigh bone, doesn’t seat properly in the hip socket. Over the years, the abnormal, repetitive movement of this femoral head can tear cartilage, called the labrum, lining the socket to provide cushioning and stability for the hip joint. In many cases a labral tear may cause no symptoms, but in cases like Kelsie’s, it may cause pain and a catching sensation in the hip.

"When you look at Kelsie’s X-rays," says pediatric orthopedic surgeon John Tis, "the first thing that jumps out at you is how shallow the socket, or cup, is. Because it’s so shallow the force isn’t distributed as well, and you can get a lot of fraying and damage to the cartilage."

Kelsie, Tis explains, needs to have a surgical procedure called a pelvic osteotomy to realign the hip and prevent the abnormal movement in the hip joint. But the surgery doesn’t address the existing damage in the socket itself, Tis stresses, only the mechanics of the hip. That’s why for patients like Kelsie, Tis recommends hip arthroscopy – a minimally invasive way to detect and treat problems like labral tears and loose cartilage, causes of the painful catching and cracking of the hip.

"Even after an osteotomy," Tis says, "the patient could still have those symptoms and pain despite the mechanical problem being fixed."

While arthroscopy has been used to treat knee problems for some time, its use to treat hip problems is relatively new, especially for pediatric patients. In hip arthroscopy, two or three small incisions are made over the hip – one to insert a tiny fiber optic camera and the others to insert instruments to treat the problem. While imaging modalities like MRI may not show a tear in the cartilage, arthroscopy provides a clear and magnified view of the pathology. Any problems Tis can treat with arthroscopic instruments, resulting in a speedier, less painful recovery than that of an open procedure.

"The advantages over an open procedure are a better view of the hip, less scarring and stiffness, fewer days in the hospital and a faster recovery," says Tis. He adds, "With the hip scope, it’s same-day surgery."

In Kelsie’s hip arthroscopy, Tis detected no damage to her hip socket, which means she can go ahead with her hip surgery. In addition to detecting and treating problems like hip dysplasia, in which the hip is abnormally formed, Tis also uses arthroscopy to diagnose and treat hip problems related to athletic injuries. For more information or patient referrals, call 410-502-9937. n