Hip Preservation Program

Patient Stories | Eva and Avascular Necrosis (AVN)

Hip Pain Leads to Eva’s Avascular Necrosis Diagnosis, Surgery and Successful Return to Gymnastics

Eva Burdeshaw was 2 years old when she started gymnastics. She quickly fell in love with the physical fun—the jumping, the tumbling, the twirling—and over the years advanced to become a Level 7 gymnast. 

“She did gymnastics 24/7,” said her mom, Allison.  

But at 11 years old, after complaining of worsening hip pain, Eva was told her gymnastics days were likely over. 

Doctors and sports medicine specialists from her hometown of Akron offered varying diagnoses from simple overuse to potentially more major conditions like Legg-Calvé-Perthes (LCP). Nothing was conclusive, yet Eva’s pain persisted. 

Allison listened to all the experts, but she also listened to herself.  

“I just had a nagging feeling in the back of my head going, ‘You need to go somewhere else,’” she said.  

Search for Second Opinion Leads to Cincinnati Children’s

This inner voice led Allison to an online support group, where many suggested she and her husband, Josh, seek a second opinion. Further research then led to Cincinnati Children’s and the highly rated Hip Preservation Program. 

In July 2018, Eva and her parents met Patrick Whitlock, MD, PhD, co-director of the Hip Preservation Center. He diagnosed her with early avascular necrosis (AVN), loss of blood flow to her hip. 

“Dr. Whitlock looked at everything and said, ‘She doesn’t have Perthes; she has AVN.’ He explained everything—what it was, what was going on,” said Allison. “He gave us focus and answered our questions and went through the whole process.” 

According to Dr. Whitlock, a single injury or traumatic repetitive injury to the right hip was the likely cause of Eva’s AVN. He suggested core decompression surgery as the first step toward Eva’s healing.

“Due to her diagnosis, the goal of [core decompression] surgery was to try to restore blood flow to the area of the femoral head that was affected so that it might repair itself,” explained Dr. Whitlock. The surgery would also decrease the risk of further collapse of the hip area and future arthritis. 

Hip Dislocation Surgery Results in Better Days for Eva

Eva’s hip did not respond well to the surgery. Concerned that the affected area could collapse completely, and needing to try something else, Dr. Whitlock and team recommended replacement of the area of AVN with a large osteochondral allograft — a piece of tissue that contains bone and cartilage taken from a deceased donor.

A month later, Dr. Whitlock performed the successful surgery, which helped to eliminate Eva’s pain and ultimately improve her overall range of motion.

She learned to walk again and slowly worked to build up her lost muscle mass—particularly in her legs. Under doctors’ orders, Eva’s physical activity was limited. She had to avoid running and jumping and refrain from impact sports like gymnastics. Not one to sit still, Eva joined the swim team.  

“It was fine to be doing something, but [swimming] wasn’t for me,” she said, matter-of-factly. The heart wants what the heart wants, and for Eva it was gymnastics. 

Aware of the Risks, Eva Returns to Gymnastics

Eva shared her desire to return to gymnastics with Dr. Whitlock, who in turn explained the increased risks, including a potential need for an earlier hip replacement. 

“We will support her in any way we can and have educated her and her family on the risks,” said Dr. Whitlock. “After appropriate counseling, they have made the choice to accept the risks in order to continue her passion.” 

Every case is different for different patients and families, explains Whitlock, adding there is little to no data regarding the outcomes and return to sport for pediatric and adolescent patients like Eva. 

“There is a balance,” said Dr. Whitlock. “My job is to really educate them as much as I can and help them make decisions as they progress.”

And in the four years since the surgery, Eva, now 15, has progressed quite well. Her physical therapy regimen focused on increasing flexibility and strength. While rehabbing, Eva never even used her wheelchair, instead preferring to move around more freely with crutch canes. 

“She would fly around in them,” Allison recalled. “To tell you the truth, that’s what worried me the most. She definitely didn’t lose her fearlessness.”  

Not her fearlessness, nor her focus and determination. Eva lost none of these personality traits as she worked hard and eventually returned to gymnastics practice in April 2019. She competes today as a Level 9 gymnast. 

“I feel fine. I’m really comfortable now,” said Eva. “I was scared [returning from injury] at first, but over time I became more comfortable. I’m not hurting anymore, and now I can do everything.” 

(Published August 2022)