UMMC - A Leader in Hip Preservation Surgery
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This article is a part of University of Maryland Rounds, which features clinical and research updates from the University of Maryland School of Medicine and University of Maryland Medical Center. See more Rounds articles.
The patient — a star, three-sport athlete — was only 14, but his hip joints appeared on X-rays to be at least three times as old, causing him a great deal of pain. When University of Maryland Medical Center orthopaedic surgeon Jason Nascone, MD, met the boy and his family, he knew the young patient could benefit from a hip osteotomy, surgery to change the shape of the hip joint that preserves a patient’s joint and averts the need for hip replacement surgery.
Practically unheard of even a decade ago, the University of Maryland is among a handful of places offering this procedure. It is increasingly being considered an option to help younger people with congenital hip dysplasia and similar hip malformations — which lead to arthritic changes in the joint — function better with less pain. In the past, these patients might undergo hip replacement surgery in their thirties, forties or fifties, but the limited longevity of prosthetic joints made multiple surgeries likely over the course of their lifespan.
“A lot of the patients who have the problems we’re addressing are not at a stage where a doctor would do a hip replacement on them,” explains Dr. Nascone, an associate professor of orthopaedics at the University of Maryland School of Medicine. “There wasn’t a thought that you could intervene. It’s a very different population than those getting a hip replacement. We’re trying to get to it that much earlier to affect the natural history of the hip.”
Solutions Tailored to Each Patient
While the goals of hip osteotomy surgery are the same for all patients, the procedure itself is typically slightly different for each one due to specific anatomical quirks. Depending on the patient, the hip socket may be too shallow, too large or too small, and the head of the femur may not be properly round. An osteotomy corrects the individual hip deformity by cutting and repositioning the bone of the femur, hip socket or both, changing the way they fit together.
Performed under general anesthesia, the surgery typically lasts between 2.5 and 4.5 hours and is well-tolerated among most patients because of their relative youth, Dr. Nascone says. As with every surgery, risks include infection or blood clots, but patients are prescribed antibiotics and blood thinners post-surgery to minimize complications.
“By six weeks post-op, patients are fully weight-bearing and have started physical therapy,” Dr. Nascone explains. “By three to six months, they notice an improvement and the preoperative pain they had is no longer there. That’s the goal of this early on, and the more global objective we’re trying to change, hopefully, is that they’re not going to need a joint replacement surgery as soon as they would. That’s the benefit much further down the line.”
UMMC 'Perfect Environment' for Procedure
Dr. Nascone’s teenage patient underwent hip preservation surgery in both hip joints, procedures that were done 8 to 12 weeks apart. Before-and-after X-rays of his hip joints show a dramatic difference, Dr. Nascone says, an improvement belied by the boy’s newly enhanced abilities on the football field, basketball court and baseball diamond.
“He is pain-free and very happy he’s had the surgeries done,” Dr. Nascone says. “The part he doesn’t realize as a kid is where his hips would have been headed. He probably would have needed hip replacement surgery in his twenties or thirties. To see him back playing sports and doing all the things he wants to do with zero pain is very satisfying to me.”
Also satisfying is the knowledge that UMMC staff members’ long and vast experience performing many types of hip operations adds credibility to the hospital’s rising reputation for hip preservation surgery.
“We offer knowledge and insight into a joint problem that many providers don’t even know to look for,” Dr. Nascone says. “At our center, we can offer solutions to problems that may not be available at other facilities, making us the perfect environment to perform this type of surgery.”