KidsMD Health Topics

Hip Impingement

  • Hip impingement is more common in boys and men who are physically active. Some famous athletes have had this condition. Many of the hockey players on the Boston Bruins have had surgery for it. The most famous hip impingement patient-athlete is Alex Rodriguez of the New York Yankees.

    –Young-Jo Kim, MD, orthopedic surgeon, Boston Children's Hospital

    If your teen or child has been diagnosed with hip impingement, you’ll have concerns and questions about his health, treatment, recovery and other issues. It may comfort you to know that Boston Children’s Hospital is a world leader in pediatric orthopedics and we have a wealth of experience helping children with this fairly common hip condition. We specialize in innovative, family-centered care that supports your child and family every step of the way.

    About hip impingement

    Hip impingement (femoral acetabular impingement or FAI) is a mechanical disorder of the hip.

    • Hip impingement is a common cause of hip stiffness and some pain
    • The condition can lead to arthritis.
    • Hip impingement commonly goes unrecognized for years, since it’s rarely painful in its early stages.
    • It’s diagnosed by noting both certain limits in hip motion and related signs on x-rays and other imaging tests.
    • If diagnosed early enough, non-surgical or surgical treatments can be very successful. If left untreated for years, the cartilage damage may be too severe for a completely successful outcome.
    • In the normal hip there is smooth gliding motion of the round head of the thighbone within the acetabulum socket.
    • Hip impingement can occur:

    The condition can affect both boys and girls, although there’s some evidence that cam impingement may be more common in boys, while pincer impingement may be more common in girls (see bullets above).

    How Boston Children's Hospital approaches hip impingement and other developmental hip conditions

    Whatever treatment your child’s hip problem requires, you can have peace of mind knowing that, as national and international orthopedics referral centers, Boston Children’s Child and Adult Hip Preservation Program and Orthopedic Center have vast experience treating children with every kind of hip condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of hip impingement.

    Unique expertise in treating adolescents with hip problems. Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child And Adult Hip Preservation Program, led by Michael Millis, MD, and Young-Jo Kim, MD, PhD, is the only such program of its kind. We offer the extensive experience and the most advanced techniques, with clinicians and researchers who are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Leaders in Bernese periacetabular osteotomy (Bernese PAO). At Children's, we’ve performed more than 1,400 Bernese periacetabular osteotomies since 1991 to correct hip dysplasia in teens and adults. Our large volume makes us the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is Boston Children’s standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically children ages 13 and older).

    One of the first programs

    Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more 6,000 procedures each year. Our program, consistently is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

    The world's most extensive pediatric hospital research enterprise

    At Boston Children’s, we’re known for our innovative treatments and a research-driven approach. We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient. 

    Hip impingement: Reviewed by Young-Jo Kim, MD
    © Boston Children's Hospital, 2011

    Contact Us

    Orthopedic Center
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Right now, you probably have lots of questions: How serious is hip impingement? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Boston Children's Hospital can explain your child’s condition fully when you meet with us.

    Background: the normal hip joint

    The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear.

    The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

    What is hip impingement?

    Hip impingement is a condition of the hip joint in which the hip’s normally smooth gliding motion is disturbed by bony deformities, causing friction between the thigh bone (femur) and the bone socket (acetabulum), which can wear away at the cartilage and can also damage the labrum, the joint’s fibrous seal.

    What causes hip impingement?

    Deformities of the thigh bone (cam impingement), acetabulum (pincer impingement) or a combination of the two abnormalities can cause hip impingement.

    • Pincer impingement occurs when there’s direct contact between the thigh bone head-neck junction and a section of the acetabular rim.
       
    • Cam impingement is caused by a squeezing or jamming of an abnormally shaped thigh bone head (femoral head) and head-neck junction into the socket (acetabulum) during certain types of motion, such as tying one's shoe, or riding a bike.
       
    • Impingement of the hip can also be caused by conditions such as 

    How common is hip impingement?

    Hip impingement is essentially a wear-and-tear condition, affecting about 20 percent of the total population. It’s more common among younger athletes—especially those in sports requiring turning, twisting and squatting motions—and physically active people. Sometimes babies are born with the condition (congenital).

    How serious is hip impingement?

    Hip impingement can cause significant pain, loss of hip motion and early arthritis. Treatment is surgical.

    How does a doctor diagnose hip impingement?

    In addition to a complete medical history and physical exam, procedures for diagnosing hip impingement may include:

    How does Boston Children’s treat hip impingement?

    Specific treatment for hip impingement is determined by your child’s doctor based on:

    • his age, overall health and medical history
    • the type, extent and severity of the impingement

    Treatment may include conservative approaches such as:

    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy

    If these don’t alleviate your child’s discomfort, doctors may perform:

    • arthroscopic or open surgery (the surgical approach and techniques depend on the cause of the condition and the degree of cartilage damage that’s already occurred)
      • Most impingements that need surgery are treated arthroscopically.
      • Open surgery can be needed if the impingement involves an abnormal angle of the hip joint.
      • Surgical techniques address the elements of hip impingement—including damaged cartilage, labral tear and friction between the ball and socket.

    Will my child be OK?

    The long-term result of surgery depends on the amount of cartilage damage present at the time of surgery. Perfect outcomes are possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair impingement if the cartilage has already been severely damaged. This is why diagnosing and treating your child’s hip impingement early in its development greatly increases the likelihood of a successful outcome, in which your child can resume full activities, including sports.

    What new research is Boston Children’s doing regarding 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. Boston Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

    The clinical and basic science researchers at Boston Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.

    FAQ

    Q: What is hip impingement?
    A:
    Hip impingement is a condition of the hip joint in which the hip’s normally smooth gliding motion is disturbed by bony deformities, causing friction between the thigh bone (femur) and the bone socket (acetabulum), which can wear away at the cartilage and can also damage the labrum, the joint’s fibrous seal.

    Q: If my child has hip impingement, will he be OK?
    A:
    The long-term result of surgery depends on the amount of cartilage damage present at the time of surgery. Perfect outcomes are possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair impingement if the cartilage has already been severely damaged. Diagnosing and treating your child’s hip impingement early in its development greatly increases the likelihood of a successful outcome, in which your child can resume full activities, including sports.    

    Q: What are the signs and symptoms of hip impingement?
    A:
    Some signs and symptoms can include:

    • stiffness in the groin or front of the thigh
    • inability to flex the hip beyond a right angle
    • pain in the groin during/after the hip has been flexed, such as running, jumping or prolonged sitting

    Q: How does Children’s treat hip impingement?
    A:
    Conservative approaches to treatment may include:

    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy

    If these don’t alleviate your child’s discomfort, doctors may perform:

    • arthroscopic or open surgery (the surgical approach and techniques depend on the cause of the condition and the degree of cartilage damage that’s already occurred)
      • Most impingements that need surgery are treated arthroscopically.
      • Open surgery can be needed if the impingement involves an abnormal angle of the hip joint.
      • Surgical techniques address the elements of hip impingement—including damaged cartilage, labral tear and friction between the ball and socket.

    Q: How long will it take for my child to heal?

    A: After surgery, your child will need to limit his weight-bearing, perhaps with crutches or a walker, for a few weeks. Physical therapy will help him restore his muscle strength. He’ll probably be able to resume full activities, including sports, after three or four months.

    Q: If my child has hip impingement, what should I ask my Children’s doctor?
    A:
    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child need treatment? Does he need surgery?
    • Will hip impingement affect his growth plate and the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • How long should my child be followed by his care team?
    • What can we do at home?

    Q: How is hip impingement usually diagnosed?
    A:
    Besides a complete medical history and physical exam, tests for hip impingement may include:

    Q: If my child has hip impingement in one hip, can he develop it in the other hip, too?
    A:
    Hip impingement can develop in one hip, or both.

    Q: What are the causes and risk factors for hip impingement?
    A:
    Hip impingement is caused by the abnormal development of the bones of the hip joint that ultimately causes damage to the joint’s cartilage. While exercise itself probably doesn’t cause hip impingement, young athletes with the condition may experience pain sooner than their less active peers.

    • Babies may be born with hip impingement (congenital).
    • Children, teens and adults may develop hip impingement (acquired).
    • Most likely, hip impingement develops from a combination of genetics and environment.
    • The condition is somewhat common in teen and young-adult athletes
      • Significant athletic activity, including contact sports, before skeletal maturity in the teen years is a possible but unproven cause.
    • There’s some evidence that cam impingement may be more common in males, while pincer impingement may be more common in females.

    Q: What’s the long-term outlook for a child who has hip impingement?
    A:
    The long-term result of surgery depends on the amount of cartilage damage present at the time of surgery. Perfect outcomes are possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair impingement if the cartilage has already been severely damaged. This is why diagnosing and treating your child’s hip impingement early in its development greatly increases the likelihood of a successful outcome, in which your child can resume full activities, including sports.

    Q: What is Children’s experience treating hip problems in children and teens?
    A:
    At Children’s, we’re known for our clinical innovations, breakthrough research and leadership in treatment for hip impingement and other hip problems. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Children’s own researchers and clinicians.

    Teens and young adults with hip problems usually need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Causes

    Hip impingement is caused by the abnormal development of the bones of the hip joint that ultimately causes damage to the joint’s cartilage. While exercise itself probably doesn’t cause hip impingement, young athletes with the condition may experience pain sooner than their less active peers.

    • Babies may be born with hip impingement (congenital).
    • Children, teens and adults may develop hip impingement (acquired).
    • Most likely, hip impingement develops from a combination of genetics and environment.
    • The condition is somewhat common in teen and young-adult athletes.
      • Significant athletic activity, including contact sports, before skeletal maturity is a possible but unproven cause.
    • There’s some evidence that cam impingement may be more common in males, while pincer impingement may be more common in females.

    Signs and symptoms

    Some signs and symptoms can include:

    • stiffness in the groin or front of the thigh
    • inability to flex the hip beyond a right angle
    • pain in the groin during/after the hip has been flexed, such as running, jumping or prolonged sitting

    When to seek medical advice

    Contact your child’s doctor if he:

    • has stiffness in the groin or front of the thigh
    • is unable to flex the hip beyond a right angle
    • has pain in the groin during/after the hip has been flexed, such as running, jumping or prolonged sitting

    Questions to ask your doctor

    If your teen or child is diagnosed with hip impingement, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns get addressed.

    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child need treatment? Does he need surgery?
    • Will hip impingement affect his growth plate and the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • How long should my child be followed by his care team?
    • What can we do at home?

    Who’s at risk

    Risk factors that increase the likelihood of hip impingement include the following:

    • Babies may be born with hip impingement (congenital).
    • Children, teens and adults may develop hip impingement (acquired).
    • Most likely, hip impingement develops from a combination of genetics and environment.
    • The condition is somewhat common in teen and young-adult athletes
      • Significant athletic activity, including contact sports, before skeletal maturity in the teen years is a possible but unproven cause.
    • There’s some evidence that cam impingement may be more common in males, while pincer impingement may be more common in females.

    Complications

    The vast majority of surgical treatments for hip impingement at Children’s occur without major complications. But patients who’ve had surgery for the condition are at a very small risk for infection, bleeding or poor bone healing (malunion).

    Long-term outlook

    The long-term result of surgery depends on the amount of cartilage damage present at the time of surgery. Perfect outcomes are possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair impingement if the cartilage has already been severely damaged. This is why diagnosing and treating your child’s hip impingement early in its development greatly increases the likelihood of a successful outcome, in which your child can resume full activities, including sports.

    For teens

    If you’re a teen with a developmental hip problem, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you may also be dealing with pain; medical appointments and procedures; and limiting some of your activities for a period of time.

    If you’re an athlete or an active person, to be experiencing pain or sitting on the sidelines for a while can be depressing and frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help you. And remember that Boston Children’s Child and Adult Hip Preservation Program is always here for you, too.

    Hip impingement glossary

    • acetabulum: hip socket; a part of the pelvis
       
    • arthritis (osteoarthritis): joint inflammation, resulting in pain, swelling, stiffness and limited movement. Arthritis can occur when a joint’s cushioning cartilage wears away
       
    • arthroscopy: minimally-invasive procedure to repair a damaged joint; through a small incision, a scope “sees” the joint and the surgeon uses instruments for repair
       
    • avascular necrosis (osteonecrosis): a condition in which poor blood supply to a bone leads to bone death; the head of the femur is a common site of this condition in a condition called Legg-Calvé-Perthes disease. This disease can be associated with hip impingement.
       
    • The Center for Families at Boston Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
       
    • cam impingement: one of the types of hip impingement; the femoral head is not round and cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum
       
    • cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move easily without pain
       
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
       
    • femoral acetabular impingement (FAI, hip impingement): medical term for hip impingement; a mechanical disorder of the hip in which the hip’s usually smooth gliding motion is disturbed by bony deformities, causing friction between the thigh bone (femur) and the bone socket (acetabulum), which can wear away at the cartilage and tear the labrum.
       
    • femoral head: round-headed top of the thigh bone (femur)
       
    • femur: the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral head) joins the hip socket (acetabulum) to form the hip joint
       
    • hip impingement: another term for femoral acetabular impingement (FAI); a mechanical disorder of the hip in which the hip’s usually smooth gliding motion is disturbed by bony deformities, causing friction between the thigh bone (femur) and the bone socket (acetabulum), which can wear away at the cartilage and tear the labrum.
       
    • labrum: a gristle-like, fibrous lining around the rim of the hip socket (acetabulum) whose cushioning characteristics provide hip joint stability and reduce friction in the joint; can be torn in hip impingement
       
    • MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body
       
    • onset (of signs or symptoms): the first appearance of signs or symptoms
       
    • open reduction surgery: a procedure in which the doctor repositions the hip bone into the socket through an incision into the patient’s body
       
    • orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the skeletal system, spine and associated muscles, joints and ligaments
       
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
       
    • osteonecrosis (avascular necrosis): the death of a bone due to loss of blood supply
       
    • pincer impingement: one of the types of hip impingement; extra bone extends out over the normal rim of the acetabulum. The labrum can be damaged under the prominent rim of the acetabulum.
       
    • physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
       
    • slipped capital femoral epiphysis (SCFE): a hip joint condition in which a weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate. It is often associated with hip impingement.
       
    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

    Unique expertise in problems of the adolescent hip

    Many teens and young adults with hip problems need diagnostic and surgical techniques that are significantly different from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program, led by Michael Millis, MD, and Young-Jo Kim, MD, is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Our complete orthopedic team

    Boston Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic center in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians. 

    Boston Children's teen advisory committee

    To help teenagers take a more proactive role in their treatment and to have their needs recognized, Boston Children’s developed the Teen Advisory Committee. The group—made up of current Children’s patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs, ensure their voices are heard.

  • At Boston Children's Hospital, we know that the first step to treating your child’s hip impingement is to form a timely, complete and accurate diagnosis. 

    Our goal is to diagnose hip impingement as early as possible in order to prevent additional damage to your child’s hip’s cartilage and labrum.

    Hip impingement test

    Your child’s doctor will conduct a physical exam, during which he or she may bring your child’s knee up towards his chest and rotate it inward. If this motion is painful, the likelihood is high that your child has hip impingement.

    The doctor will also take a family history (including any hip problems in your family) and may use diagnostic tests to get detailed images of your child’s hip joint, including:

    Our Orthopedic Clinical Effectiveness Research Center (CERC)

    Boston Children’s Orthopedic Clinical Effectiveness Research Center (CERC) was established by the Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world.

    If you come from far away, we can help

    As an international pediatric orthopedics center, Boston Children’s cares for young patients from all over the world. Our International Center assists families residing outside the United States: facilitating the medical review of patient records; coordinating appointment scheduling; and helping families with customs and immigration, transportation, hotel and housing accommodations.

  • Boston Children's Hospital's hip sub-specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

    How we'll treat your child's hip impingement depends on:

    • his age, overall health and medical history
    • the type, extent and severity of the impingement—including how much damage has already occurred to the cartilage

    Non-surgical treatments

    Treatments may include conservative approaches such as:

    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy

    Surgery

    If the above treatments prove inadequate to stopping your child's pain, doctors may perform:

    • arthroscopic or open surgery (the surgical approach and techniques depend on the cause of the condition and the degree of cartilage damage that's already occurred)
      • Most impingements that need surgery are treated arthroscopically.
      • Open surgery can be needed if the impingement involves an abnormal angle of the hip joint.
      • Surgical techniques address the elements of hip impingement—including damaged cartilage, labral tear and friction between the ball and socket.

    After surgery

    After surgery, your child will need to limit his weight-bearing, perhaps with crutches or a walker, for a few weeks. Physical therapy will help him restore his muscle strength. He'll probably be able to resume full activities, including sports, after three or four months.

    Long-term outlook

    The long-term result of surgery depends on the amount of cartilage damage present at the time of surgery. Perfect outcomes are possible with early joint preserving treatments prior to cartilage damage. Diagnosing and treating your child's hip impingement early in its development greatly increases the likelihood of a successful outcome.

    Coping and support

    At Boston Children's, we understand that a hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions when your child is diagnosed with hip impingement. Will my child need surgery? How long will his recovery take? Will it affect him long term? What should we do at home? Boston Children's can help you connect with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists will be on hand to walk you through your child's diagnosis, surgery and recovery. And once your child is home, we'll help you coordinate and continue the care and support he received at Boston Children's.
       
    • parent-to-parent: Want to talk with someone whose child has been treated for hip impingement? Our Orthopedic Center can often put you in touch with other families who've been through the same experience that you and your child are facing.
       
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
       
    • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.

    A long line of orthopedic firsts

    With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Boston Children's is home to many orthopedic breakthroughs, including:

    • a hip program that has performed more than 1,400 Bernese periacetabular osteotomies
    • one of the first scoliosis clinics in the nation
    • advances in our Spinal Program, such as video-assisted thorascopic surgery
    • advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity

    Boston Children's is also:

    • the oldest and largest comprehensive center for the care of spina bifida
    • one of the first pediatric sports medicine clinics in the nation
    • one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma

    The Experience Journal

    Designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.

  • For more than a century, orthopedic surgeons and investigators at Boston Children's Hospital 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 Boston Children’s Orthopedic Center and Child and Adult Hip Preservation 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 Boston 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. 
    • 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.
       
    • Boston 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, and enrolls more than 500 patients each year in various studies.

    Orthopedic basic science laboratories

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

    Children speak about what it's like to be a medical research subject

    View a video of a day in the life of Boston Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science. 

    Boston Children's Hip Program's unique insight and expertise

    Boston Children’s Child and Adult Hip Preservation Program enjoys a special degree of effectiveness—not just because of our long tradition of excellence in pediatric hip care, but also because we follow our patients through adulthood. This gives us a unique perspective, insight and expertise—we can track how the hip works in each age group, how the problems evolve, and how the hip’s function changes over time in adult patients who’ve had treatment in childhood. 

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