Hip impingement

For more than a century, orthopedic surgeons and investigators at Children’s Hospital Boston have played a vital role in advancing the field of musculoskeletal research. We’ve developed breakthrough treatments and major advances for conditions developmental hip problems such as hip impingement, as well as scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.

In Children’s Orthopedic Center and Adolescent and Young Adult Hip Program, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:

• full-time basic scientists
• 28 clinical investigators
• a team of research coordinators and statisticians

Studies of developmental hip conditions

Developmental hip conditions such as hip impingement, slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

Current and recent studies include the following:

• We’re conducting a large number of ongoing studies to follow patients who’ve had various treatments for SCFE and hip dysplasia. Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.

For example, a very common hip condition called femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a frequent cause of osteoarthritis of the hip. FAI is a jamming that occurs in some hips, resulting in damage to the cartilage. The most common cause of FAI is a “bump” on the neck of the femur that remains as a result of SCFE. The impingement can be small (causing minor damage) or larger (creating cumulative damage to the cartilage inside the hip and resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.

• We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct hip dysplasia in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.
  
  PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically teens ages 13 and older—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.
  
  We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
   
• We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage. Read more.
   
• We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in people with developmental dysplasia of the hip. Read more.
   
• Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. The group now comprises 10 centers in the United States and one in Europe, andenrolls more than 500 patients each year in various studies.

Orthopedic basic science laboratories

Working in Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

• Orthopedic basic science research
• Center for the study of genetic skeletal disorders
• Sports Medicine research laboratory
• Bone cell biology laboratory
• Matthew Harris lab

  Children speak about what it’s like to be a medical research subject
  View a video of a day in the life of Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.