Hip Deformity Service

We monitor hip dysplasia in infants with examinations and serial ultrasounds. We use the Pavlik harness in reducible hips (ball of the hip goes into the socket). In infants with irreducible hips (ball does not go into the socket), we perform a closed reduction of the hip, in which the ball of the hip is gently redirected to the socket, in the operating room. In older infants and toddlers, an open reduction with pelvic and femoral osteotomies may be necessary. We use hip spica casts routinely.

Older children, adolescents and young adults are candidates for different procedures based on the severity of the dysplasia and skeletal maturity.  We perform hip arthroscopy or surgical dislocation to treat femoroacetabular impingement (FAI) and other hip joint pathology. The periacetabular osteotomy (PAO) is another hip preservation technique. We reserve total hip replacements for selected patients.

Our approach to the treatment of Legg-Calve-Perthes (LCP) addresses two key elements – motion and containment.  In patients with mild LCP, we limit running and jumping, encourage low-impact exercises such as swimming and bicycling, and have our physical therapists help maintain and improve range of motion.  In children with more significant involvement, we use a two-step surgical protocol.  The first surgery consists of a soft-tissue release and application of a Petrie cast to place the ball of the hip more securely in the socket.  Children return in six weeks for cast removal and whirlpool therapy in preparation for the second operation, which consists of a pelvic osteotomy and or a shelf augmentation and immobilization in a cast.  We do a trochanteric epiphysiodesis to limit the relative overgrowth of the greater trochanter to minimize the child’s limp in the future.

Adolescents with a stable slipped capital femoral epiphysis (SCFE) undergo percutaneous screw fixation using a small incision to prevent the ball of the hip from deforming through the growth plate. Patients with more deformity or joint pathology may require an osteotomy or a surgical dislocation.