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VOL. 129 | NO. 10 | Wednesday, January 15, 2014

Hip Preservation

Campbell Clinic program treats joint issues for children, young adults

By Don Wade

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Looking back, Cathy Rogers sees there were clues that then seemed mere oddities.

When her son Joshua was in middle school, he could make a “popping sound” with his left hip. Though Joshua was active and sometimes would take three-mile runs, she eventually noticed that he didn’t tie his shoes like anyone else in the family.

Dr. David D. Spence works in Campbell Clinic’s Hip Preservation Program, which treats joint issues for children and young adults. 

(Daily News/Andrew J. Breig)

“He never bent over to tie his shoes,” Rogers said. “He always lifted his foot up to tie his shoes. He just learned to adapt over the years to his hip hurting.”

Then came the day in 2012 – Joshua was in high school by this point – when he went to Buffalo Wild Wings with some friends. He stepped off a curb and everything changed – excruciating pain, so much that he couldn’t walk.

At one level, Joshua, now 18, already was a statistic. Dr. David Spence, who works in Campbell Clinic’s Hip Preservation Program, said broad population studies in Scandinavia have shown that about 25 percent of males, and 10 percent of females, have some structural hip abnormality.

This was true for Joshua. In fact, once Joshua went to Campbell Clinic for testing it was discovered that he had impingements in both hips. Now, the challenge was to keep Joshua from joining another statistical group.

One in four people will develop end-stage hip arthritis in their lifetime, according to the Centers for Disease Control. More than 250,000 total hip replacements are performed each year in the United States.

Up to 90 percent of hip arthritis cases can be attributed to an underlying hip condition that may be present as early as childhood or adolescence, Spence said. About half of that 90 percent, he says, have what Joshua has – an impingement, “or a conflict between the ball and the socket” of the hip. The other half has dysplasia, or hip instability.

“A total hip replacement for people that are 65 and up is an excellent surgery,” Spence said. “There’s a 98 percent satisfaction rate. But if you do it in young people, then you need revision surgeries. The complications are higher. The functions of those hips are a little bit lower over the lifetime of the hip.”

In Joshua’s case, Spence first performed an arthroscopic surgery on the left hip. Cathy Rogers said her son felt almost immediate relief from his pain. That was the good news. The bad news was that he would need the same procedure on the right hip. Joshua had the second operation last September and though his days as a runner are over, he is active again – biking, swimming and golfing.

Results of these procedures that are less invasive than a total hip replacement are encouraging, Spence said, with 80 to 90 percent of patients not needing total hip replacement 10 to 20 years later. But it’s crucial, he said, to catch the underlying structural problems early.

Several signs that there may be a structural hip abnormality:

Recurring groin pain. People often think they have pulled a muscle, Spence says, “But that can be a sign you’ve got impingement that over time is causing irreparable damage to your hip joint.”

Pain with prolonged periods of sitting – such as in a car or movie theater.

Hip pain immediately after activity.

Pain that does not improve within a couple of weeks.

And, like Joshua, trouble putting on your socks and shoes.

At Campbell’s Hip Preservation Program, a detailed history will be taken of new patients and appropriate diagnostic tests administered. This may signal a need to begin therapy or point toward an arthroscopic procedure.

“Therapy, strengthening, and stretching can relieve stress across a joint,” Spence said, adding that patients also need to monitor their weight to reduce stress. “We can do injections that could be therapeutic and often are diagnostic as well.”

Although sports, per se, don’t cause hip problems, they can worsen them.

“Activities that cause a lot of hyper-physiological, abnormal motion, like ballet and gymnastics that put a lot of stress on a hip at the limit of that motion are problematic,” Spence said.

Meanwhile, Joshua is about to graduate Southaven High School and head off to study engineering at Mississippi State.

“At first he was really mad he couldn’t run,” his mother said. “But now he’s just thankful that his hips are fixed.”

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