Patient Stories

Young and Hip... Pain

Mar. 29, 2021

Experts see a rise in young adults getting hip replacements, but UC Health surgeons offer alternatives not available anywhere else in Cincinnati.

There are more than 300 joints in the human body. Along with the knee joint, the hip joint is one of the largest weight-bearing joints impacting all aspects of our mobility. The hip is uniquely designed to provide stability while allowing a large range of motion. This combination enables the body to transmit significant forces from the legs to the rest of the body while we walk, run, and lift things, while simultaneously allowing us to sit, squat and bend over to pick things off the floor.

Because of this flexibility and extensive functionality, the hip joint is more prone to injury and degeneration (wear and tear).

Experts are seeing a rise in hip replacement surgeries not only in the elderly, but also in young active patients — some as young as 18 years old.

Henry Claude Sagi, MD, professor in the Department of Orthopaedics & Sports Medicine at the University of Cincinnati College of Medicine and director of Orthopaedic Trauma Surgery at UC Health, and Christopher J. Utz, MD, assistant professor in the Department of Orthopaedics & Sports Medicine at the UC College of Medicine and a UC Health orthopaedic surgeon, partner to provide Cincinnati’s only comprehensive adult hip preservation program.

“More young patients are getting hip replacements at a younger age because the technology is better,” Dr. Sagi explained. “The replacement lasts longer, and the indications for hip replacements have changed, from severe debilitating arthritis in elderly patients, to milder forms of arthritis that limits general function and activity in younger patients.”

But, at UC Health, hip replacements are a last resort for young adults.

Common Hip Injuries and Conditions in Young Adults

Whether genetic, developmental or due to traumatic injury, Dr. Sagi and Dr. Utz provide hip preservation treatments, typically for patients ages 18 to 35 years old. These treatments are designed to improve and prolong the natural hip function in an effort to prevent arthritis and, ultimately, eliminate the need for a total hip replacement later on in life. This allows young adults to get back to their normal activity levels, something a hip replacement would likely prohibit.

The most common hip injuries and conditions seen in young adults are:

  • Labral tears. The tissue that attaches to the edge of the hip socket is torn due to traumatic injury or chronic impingement because of how the hips are formed. Impingement occurs when the bone from the ball repeatedly rubs and compresses against the cartilage on the rim of the socket, causing a sharp, pinching pain, eventual tearing.
  • Hip impingement. Medically referred to as femoroacetabular impingement (FAI) in which there is abnormal contact and friction between the ball and socket of the hip, which results in damage to the cartilage and labrum. Hip impingement is a major factor contributing to the early onset of arthritis in those under 40 years of age. Many people don’t even realize they have hip impingement in its early phases until it becomes more severe and painful, and requires treatment.
  • Adult hip dysplasia. Generally speaking, there are two forms of hip dysplasia: congenital (or developmental) dislocation of the hip (CDH or DDH) and adult dysplasia.

CDH refers to dislocation of the hip due to abnormal development of the hip joint and acetabulum, or socket, at the time of birth or less than 3 years old that results in hip instability.

“While CDH or DDH are essentially interchangeable, DDH is more commonly used as it more properly defines the whole spectrum of pathology that can occur with this condition,” Dr. Sagi explained. “Newborns and infants tend to have more severe forms of the condition resulting in greater instability with dislocation (CDH), whereas young adults have lesser degrees of instability that occur after many years of activity that gradually cause wear and pain without dislocation.”

Both are conditions where the hip socket is shallower than normal and does not contain or cover the ball adequately, causing pain, limiting and overall feelings of instability.

Adult dysplasia is a condition where the hip joint has a shallow socket and gradually becomes loose overtime.

“At UC Health, we see patients with adult dysplasia,” Dr. Utz said. “Our patients’ hip joints became more unstable as they got older and weren’t severe enough to warrant treatment as a child.”

Meet Payton Whitt

At just 22 years old, Payton was already a regular patient of UC Health Orthopaedics & Sports Medicine. She had been seeing Angelo Colosimo, MD, UC Health orthopaedic surgeon and associate professor in the Department of Orthopaedics & Sports Medicine at the UC College of Medicine, for a previous injury and told him that she had developed extreme pain in her right hip.

An MRI showed a labral tear in Payton’s hip, so Dr. Colosimo referred her to Dr. Utz to address the labral tear, but she learned that would not address the underlying condition, which was hip dysplasia.

World-Renowned Hip Experts at UC Health

Treating the hip joint is extremely complex as it is located deep within the pelvis and surrounded by ligaments and muscles, requiring orthopaedic surgeons with a unique subset of skills and extensive training to accurately identify the source of their patients’ pain.  

“Unlike the knee or shoulder, we can’t touch or feel the parts of the hip joint itself,” said Dr. Utz. “Meaning, it can be difficult to determine whether the hip pain is actually from the joint itself, or the surrounding ligaments, muscles or nerves.”

Dr. Utz is just one of a handful of Cincinnati orthopaedic surgeons who are able to address hip impingement and labral tears. These hip conditions specifically require a precise, minimally invasive (smaller incision) arthroscopic approach that few surgeons have in their toolbox. Other more severe conditions may require an open (larger incision) or combined approach to fully repair the joint and treat the underlying cause of pain.

In addition to his clinical practice where he cares for both amateur and professional athletes. Dr. Utz researches injury prevention strategies and preoperative predictors of outcomes in total joint arthroplasty and hip arthroscopy.

His partner in hip preservation, Dr. Sagi, joined UC Health in 2018, bringing world-renowned expertise and leadership in orthopaedic trauma and pelvic/hip fracture patients. He and Michael T. Archdeacon, MD, Peter J. Stern Professor and Chair in the Department of Orthopaedic Surgery at the UC College of Medicine and a UC Health orthopaedic surgeon, developed and popularized a surgical approach to treat pelvic and acetabular (socket of the hip bone) trauma that is now being used around the world.

Alternative Approaches to Hip Replacements

Hip preservation techniques, such as arthroscopic repair and periacetabular/femoral osteotomies are not commonly performed by the majority of orthopaedic surgeons.

  • Periacetabular osteotomies (PAO). PAO is a complex surgical technique for patients under 35 years old that requires cutting the pelvic bone around the hip socket to realign it, alleviating the stress that was previously being placed on the hip joint ligaments and cartilage.  
  • Femoral derotational osteotomies. This technique is used in just a small percentage of patients in which the upper thigh bone (femur) is sculpted to be repositioned. This allows for weight to be held on a healthy part of the femoral head.

“They are very complex surgeries that most surgeons don’t have the experience or skills to perform well,” said Dr. Utz. “These procedures do typically have a longer recovery time than a traditional hip replacement, but can be more beneficial in the long run.”

Dr. Utz connected Payton with Dr. Sagi to address her hip dysplasia. Both Dr. Utz and Dr. Sagi were able to perform Payton’s surgery together —  Dr. Sagi performed the PAO and Dr. Utz performed the labral tear repair.

“Today, I feel great,” said Payton. “I am now five months post-op, and I haven’t had any pain or discomfort. I am walking better than I have in years.”

UC Health Orthopaedics & Sports Medicine is comprised of both arthroscopic and open hip surgeons, which enables us to address these complex hip conditions at all time points along the spectrum of DDH and preserve the hip’s natural form and function — delaying, and possibly preventing, the need for a total reconstruction later on in life.

Payton shared, “At UC Health, I am listened to and I am respected. I always feel like I am in the best hands when I’m there.”

To schedule an appointment with UC Health Orthopaedics & Sports Medicine, call 513-475-8690.