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.