This brief video reveals the many hip conditions affecting pediatric patients that can be addressed through minimally invasive techniques – to resolve pain, restore quality of life, and minimize the risk of future arthritis. With a focus on femoroacetabular impingement (possibly the most common hip disorder in young people), orthopedic surgeon Michael Chau, MD, PhD, discusses initial treatment steps and keys to knowing when to consider surgical options, including arthroscopy.
Hello. My name is Michael Chow. I'm a pediatric orthopedic surgeon who specializes in sports medicine and hip preservation for children, adolescents and young adults at UCSF Moff Children's Hospital. One surgical technique that I perform is hip arthroscopy. I'm going to speak about what this operation is and how it can benefit patients with a variety of hip pathologies. Ultimately, the goal is to help patients return to normal activities pain-free and to minimize the risk of developing premature arthritis. Briefly about me and my role here at UCSF. After orthopedic surgery residency, I completed two fellowships, first in pediatric orthopedics, and second in orthopedic sports medicine. I then dedicated additional time on a traveling fellowship to learn how hip preservation is being done in different regions of the United States and across the world. My current practice is comprised of hip preservation, sports medicine, and orthopedic trauma. I also enjoy educating the future generation in scientific research at UCSF. I work as part of a team at the Hip Preservation Center. Where we have a diversity of orthopedic providers from non-surgical to surgical. We hold monthly hip preservation conferences where we discuss surgical indications and review postoperative cases. I believe it is invaluable to share our experiences and perspectives in order to provide up to-date evidence-based and unbiased care for our patients. I'm based on multiple locations on both sides of the bay, including Oakland. Wanna Creek and San Francisco at UCSF Benioff Children's Hospital, we are lucky to have access to basic and advanced imaging. Our primary care sports medicine specialists can perform image guided hip injections for both therapeutic and diagnostic purposes. Our physical therapists specialize in working with young athletes and offer the spectrum of non-surgical management, postoperative rehabilitation, and injury prevention programs. I myself am trained in both arthroscopic and open hip preservation techniques. What is hip arthroscopy? Hip arthroscopy is a minimally invasive procedure that uses a camera and low profile instruments through 2 to 3 small incisions around the hip. This allows the surgeon to view inside the joint under high bandification. The technique was developed in the 1970s, but was not widely adopted until the 1990s. It has since been continually refined as our technologies have advanced. There are numerous advantages of hip arthroscopy over open hip surgery, including small incisions, less pain, lower infection risk, same day surgery, and faster recovery. In the young athletic hip, there are many potential pain generators. A comprehensive approach to diagnosing the cause of hip pain is knowing the anatomy 360 degrees around the hip, including major structures such as bone, cartilage, muscle, tendon, ligament, bursa, and nerves. The role for hip arthroscopy is growing. It can be used to address the highlighted injuries and conditions. A recent review by the Pediatric Research and Sports Medicine Society or PRISM. Listed common indications for hip arthroscopy in the pediatric population. At the top of this list is femoral acetar impingement and chondrolabral injuries followed by post slipped cap femoral epiphysis. I have found this to be true in my own practice, so I will spend some time talking about my understanding of these conditions. Femoral acetabular impingement is a condition that causes hip pain and dysfunction due to structural mismatch between the femoral head neck junction and acetabular rim, and this can lead to labral and articular cartilage injury. In simplistic terms, femoral acetabular impingement is like trying to jam a square femoral head into a hemispherical acetabular socket. It simply does not fit. There are 3 types including cam on the femoral side, pincer on the Staber side, and mixed. The cause of femoral acetabular impingement can be congenital or developmental, but is not always known. Due to the malleability of the cartilaginous growth centers, it is thought that sports with increased or abnormal loading of the hip can be associated with the development of femoral acetabular impingement. It can also be a sequela of childhood trauma. Initial treatment typically consists of rest. Activity modification, non-steroidal anti-inflammatory drugs, and physical therapy. Hip injections can also be beneficial. Surgery is indicated after failure of non-operative treatment or if there is a significant bony deformity. Hip arthroscopy is highly versatile. There are many tools in the shed. Laberal injuries can be debrided if small, repaired, augmented with other tissues such as the ilotibial band, or reconstructed if unsalvageable. Chondral injuries can be debrided if small, stimulated to regenerate or replaced. Bony deformities can be reshaped or sculpted. Using a small burr that requires a systematic approach or even an artistic touch. This is a case of a 19 year old male patient who presented to my clinic with chronic left hip pain after healing a slipped capital femoral epiphysis. The condition caused residual femoral acetabular impingement that prevented the patient from being able to move his hip without pain. At our center, we have the option of obtaining advanced imaging in the form of either a CT or MRI and generating 3D printed models for preoperative planning, which can be particularly helpful for cases of severe deformity. In this case, intraoperative fluoroscopy was used for guidance and to confirm adequate resection. The X-rays on the bottom right show postoperative images with a more normal pairing thermal head neck junction. After hip arthroscopy, the patient was able to better move his hip and walk without pain. Thus far, he has not wanted to proceed with additional procedures. This is a case of a 16 year old female who presented to my clinic with chronic right hip pain after a hyperextension injury. Imaging demonstrated a pincer type femoral stabular impingement and associated chondrolabral injury. The patient initially attempted but failed a long course of non-surgical management including intra-articular hip injections. She ultimately underwent hip arthroscopy that confirmed labral instability and cartilage dilamination. Acetabuloplasty and labor repair were performed after surgery, her pain improved, and she is progressing through a multi-phase rehabilitation program with our physical therapists. Return to sport after arthroscopic hip procedures such as this case is typically 6 months. In summary, What sets UCSF Benioff Children's Hospital apart as a hip preservation center is that it offers multidisciplinary, non-surgical, and surgical treatment of hip pathologies in children, adolescents and young adults. Hip arthroscopy is a minimally invasive surgical technique that has broad applications and numerous advantages over open hip surgery when indicated. The field of hip preservation is vital to allow young athletes to stay in their sport and reduce the risk of developing premature arthritis. For further information, please follow the QR code on the screen. Thanks for your time and I hope you found this video informative.