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Hip disease is frequently linked to aging, but many hip problems begin at birth or during development of the hip with structural abnormalities. These variations can cause excessive wear on hip joints long before aging is a factor.
For younger patients with hip conditions, it’s essential to preserve as much of the existing hip as possible. The Hip Preservation Program at Indiana University Health has been designed to meet the unique needs of young patients with developmental hip problems like dysplasia or acquired problems resulting from injuries. We provide the latest surgical options to preserve the existing hip while protecting you from future joint damage. Our multidisciplinary team of orthopedic surgeons, radiologists, sports medicine specialists and physical therapists use advanced techniques to return you to the activities you love as quickly and safely as possible.
Hip Problems in Young Adults
Hip pain or impaired movement in young adults can be caused by inherited conditions, overuse due to high levels of activity or even injury. Our Hip Preservation Program helps children and young adults with a full range of hip problems, including the conditions listed below.
Congenital Hip Dysplasia
The most common cause of hip pain and other problems for young adults is congenital hip dysplasia. People with this condition are born with a femoral head (the ball at the end of the thigh bone) that does not fit properly into the acetabulum (hip socket on the pelvis). If you have hip dysplasia, you may experience pain in your hip during activities such as walking, running or dancing.
Though you are born with congenital hip dysplasia, you may not experience any symptoms until your 20s or 30s. Active young adults, such as student athletes, may experience pain earlier in life. The average hip dysplasia patient is a woman in her early 20s. Hip dysplasia is about four times more common in women than men.
Hip dysplasia damages the bone and cartilage of the hip and can cause osteoarthritis to develop at a young age. It is essential to diagnose hip dysplasia as early as possible to prevent arthritis. Hip dysplasia is commonly diagnosed using imaging technologies such as X-rays or magnetic resonance imaging (MRI).
A femoroacetabular impingement means the femoral head and hip socket do not fit together correctly because of excess bone growth. For some people, this causes sharp pain in the groin or outer hip and damage to the cartilage. This type of hip impingement might also cause damage to the articular cartilage and lead to osteoarthritis.
Contracted Joint Capsules
A joint capsule is the space around where two bones meet. In your hip, it is the area around and between the femoral head and acetabulum. This area should remain flexible and be filled with fluid that helps you move.
If the joint capsule becomes contracted due to nerve damage, disease or injury, the muscles around the joint are shortened. The joint becomes stiff and painful, and your movement is impaired. Medications, physical therapy and surgery may be necessary to loosen the joint and increase range of motion.
Bone spurs are small growths in your joints that can cause sharp pains. They are usually caused by excessive use or damage done by one of the conditions mentioned above. Removing the bone spurs reduces pain.
Cartilage damage can be caused by athletic or recreational activities that put pressure or strain on your joints. It usually does not cause pain or other symptoms until you are older, unless you suffer from one of the conditions listed above. Getting rid of damaged cartilage can lessen your pain and prevent arthritis.
Hip Preserving Treatment Options
Our Hip Preservation Program offers innovative, comprehensive treatment options for all hip problems that affect young adults. Our experienced physicians will work with you every step of the way, from diagnosis to treatment and recovery, to select the treatment option that best fits your needs.
Hip arthroscopy is a minimally invasive technique that can be used to repair damaged cartilage, shave off bone spurs or remove tissue. During the procedure, your surgeon will make small incisions around your hip joint. A small camera will be inserted into the joint to allow your surgeon to clearly see what work needs to be done to reduce pain and improve hip function.
Arthroscopy poses few risks and has a quick recovery time. It’s most often used if nonsurgical treatments, such as injections, pain medications or physical therapy, don’t improve your condition.
Hip arthroscopy helps improve the following conditions:
- Labral damage
- Femoralacetabular impingement
- Damaged or torn cartilage
- Contracted joint capsules
- Bone spurs or abnormalities that could decrease range of motion
Periacetabular osteotomy is an advanced surgical procedure that corrects congenital hip dysplasia by moving the hip socket into the best possible position. By repositioning the socket, less pressure is put on hip cartilage, reducing damage and the risk for arthritis while preserving hip function. This surgery may allow patients to delay or even avoid hip replacement, which is pivotal for young adults since most hip replacements last only 20 years.
During periacetabular osteotomy, the hip socket is cut away from the pelvis and repositioned to fit over the femoral head. The hip socket is then reattached to the pelvis with multiple screws to allow it to heal in the correct position.
Periacetabular osteotomy requires general anesthesia and a four to five inch incision on the front part of your hip. It carries the same risks as most surgeries, including infection, pain and complications with anesthesia. You will spend two to four days in the hospital after the surgery.
Because it is a major operation, you must wait six to eight weeks before putting any weight on the hip, including standing or walking. Our team of specialists will assist you with physical rehabilitation and strength training, as well as pain management. Most patients report no pain eight weeks after the surgery, around the time they walk again. After four months, most patients resume normal activities and experience no pain.
Femoral Head/Acetabular Osteoplasty
Femoral head/acetabular osteoplasty helps remove abnormalities in the bone that cause femoroacetabular impingement. If the bone cannot be corrected using minimally invasive arthroscopy, this open surgical procedure will allow your surgeon to make the necessary changes to the bone structure. This surgery improves your range of motion and reduces the pain associated with hip impingement.
Femoral head/acetabular osteoplasty takes between an hour and two hours. You will be put under general anesthesia for the duration of the surgery. The incision for this surgery is usually around three or four inches long.
Most patients only need to stay at the hospital for one night following surgery. It carries many of the same risks as normal surgery, such as infection, pain or complications from anesthesia. Though you cannot put any weight on the hip or rotate your hip for up to six weeks after surgery, you will be able to use crutches to get around. After six weeks, you will work with our physical therapists to ensure you do not push your hip too far before it is ready to be used.
Our Surgical Expertise
Our orthopedic surgeons are experts with years of experience in preserving hip function in young adults. Our physicians are fellowship-trained and conduct research in orthopedics to share valuable knowledge with the medical community about the specialized operations performed at IU Health. Our Hip Preservation Program includes the following experts from our nationally-ranked IU Health Orthopedics & Sports Medicine practice:
Todd McKinley, MD
Dr. McKinley is an orthopedic trauma surgeon who manages major injuries to the limbs, pelvis and spine. He has been caring for young hip pain patients for 15 years. He is one of the few U.S. physicians who performs elective pelvic osteotomies for hip preservation and has performed over 400 of these operations. Before joining IU Health in 2012, Dr. McKinley served as a professor of orthopedic surgery in the department of orthopedic surgery and staff surgeon for orthopedic trauma services at the University of Iowa Hospitals and Clinics. He earned his bachelor’s degree in aerospace engineering and mechanics from the University of Minnesota Institute of Technology and his medical degree from the University of Minnesota Medical School.
Walter Virkus, MD
Dr. Virkus is a leading surgeon who has sharpened his skills at some of the busiest trauma centers in the country, including the Level I Trauma Center at IU Health Methodist Hospital. Before joining IU Health as director of orthopedic trauma services in 2012, Dr. Virkus worked for 12 years as a member of the department of orthopedic surgery at Rush University Medical Center, where he started the Young Hip Program and served as its director. He also served for four years as the program director for the center’s residency program. Dr. Virkus has a diverse practice that includes orthopedic trauma, orthopedic oncology and hip reconstruction. He treats nonunions, malunions and orthopedic infections, and performs hip osteotomies. After graduating from New Jersey Medical School, Dr. Virkus completed an internship at Mount Sinai Medical Center in New York and a residency at University of Maryland. Afterwards, he finished trauma fellowships at Hospital for Special Surgery in New York and Shock Trauma Center in Baltimore. He also completed an orthopedic oncology fellowship at the University of Florida.
Christine Caltoum, MD
Dr. Caltoum specializes in pediatric orthopedic surgery and sports medicine. Her clinical interests include sports and athletic injuries, pediatric orthopedic clinical services, pediatric trauma, hip disorders and limb deformities.
Dr. Caltoum earned her medical degree from the Wayne State University School of Medicine in Detroit. She completed her residency training at the Mayo Graduate School of Medicine in Rochester, MN, and a fellowship at Children’s Hospital and Health Center in San Diego, CA. She is board certified in orthopedic surgery. She is also the residency program director for the Department of Orthopaedic Surgery at IU School of Medicine.
Patient Stories & Resources
Read more about our patients' journeys and their return back to heathy activity as well as access blog and video resources on developmental hip preserving treatments and options.