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.”