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Knock Knees

  • Overview

    "Out of all the thousands of kids we see for this condition, maybe one in 1,000 won't straighten naturally. Just about 99 percent of the time, a 3- or 4-year-old with physiologic genu valgum is going to be just fine."

    Samantha Spencer, MD, orthopedic surgeon, Children?s Hospital Boston

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

    What to know about knock knees

    • Knock knees are angular deformities at the knee, in which the head of the deformity points inward.
    • A standing child whose knees touch but whose ankles do not is usually said to have knock knees.
    • During childhood, knock knees are a stage in normal growth and development (physiologic valgus).*

    * Between birth and 18 months, an outward-turning (varus) alignment from hip to knee to ankle is normal. Between about 18 and 24 months, this alignment normally becomes neutral. When the child is between 2 and 5 years old, an inward-turning (valgus) alignment is normal. The alignment returns to neutral as the child grows.

    • The condition is slightly more common in girls, although boys can develop it, too.
    • The condition usually becomes apparent when a child is 2 to 3 years old and may increase in severity until about age 4.
    • Knock knees usually correct themselves by the time a child is 7 or 8 years old. Occasionally, the condition persists into adolescence.
    • If the condition doesn’t appear until a child is 6 or older, she may have an underlying bone disease (pathologic valgus), and the condition may be more serious.
    • Obesity can contribute to knock knees—or can cause gait (manner of walking) problems that resemble, but aren’t actually, knock knees.

    How Boston Children's Hospital approaches knock knees
    Doctors at Children's closely monitor your child’s leg development, to make sure that her legs straighten themselves naturally. In the unlikely event that the condition doesn’t self-correct, your child’s doctors may have her wear corrective leg braces. Only children with the most severe cases may need surgery.

    Whatever observation or treatment your child needs, you can have peace of mind knowing that as a national and international orthopedics referral center, our Orthopedic Center has vast experience treating children with every kind of developmental condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every severity level of knock knees.

    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 5,000 procedures each year. Our program, consistently ranked among the top three in the country by U.S. News & World Report, 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 research enterprise
    At Children’s, we’re known for our innovative treatments and a research-driven approach. We’re home to the world’s most extensive pediatric 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.

     

    Among the highest in the nation in children’s orthopedics

    Ranked#1  in the country by U.S. News & World Report in 2012-2013, our orthopedic team offers comprehensive care for a wide variety of congenital and acquired disorders. Our Orthopedic Center is known for an outstanding level of clinical innovation, research and leadership. We offer the most advanced diagnostics and treatments—several of which were developed and pioneered by our own researchers and clinicians.

    Orthopedic care in lots of places
    Boston Children’s physicians provide orthopedic care at locations in Lexington, Peabody, Weymouth and Waltham, as well as at our main campus in Boston.     

     

    Knock knees: Reviewed by Samantha Spencer, MD

    © Children’s Hospital Boston, 2011

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

     617-355-6021

  • In-Depth

    Right now, you probably have lots of questions: How serious are knock knees? Does my child need treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Children’s Hospital Boston can explain your child’s condition fully when you meet with us.

    What are knock knees, and when do they become obvious?
    Knock knees are angular deformities at the knee, in which the head of the deformity points inward. A standing child whose knees touch, but whose ankles do not, is usually said to have knock knees. During early childhood, knock knees are a part of normal growth and development.

    The condition usually becomes apparent when a child is 2 to 3 years old, and it may increase in severity until about age 4. It usually self-corrects by the time a child is about 7 or 8 years old. But if the condition doesn’t appear until a child is 6 or older, it could be a sign that she has an underlying bone disease.

    During early childhood, knock-knees actually help a child to maintain balance, particularly when she begins to walk, or if her foot rolls inward or turns outward. When a child has knock knees, both knees usually lean inward symmetrically. One knee, however, may "knock" less than the other, or may even remain straight.

    Knock knees usually correct themselves by the time a child is 7 or 8 years old. Occasionally, they persist into adolescence.

    What causes knock knees?
     

    • Knock knees are usually part of the normal growth and development of the lower extremities.
    • Some cases, especially in a child who’s 6 or older, may be a sign of an underlying bone disease, such as osteomalacia or rickets.
    • Obesity can contribute to knock knees—or can cause gait (walking) problems that resemble, but aren’t actually, knock knees.
    • The condition can occasionally result from an injury to the growth area of the shin bone (tibia), which may result in just one knocked knee.

    What are the signs and symptoms of knock knees?

    A standing child of average weight whose knees touch, but whose ankles do not, is usually considered to have knock knees. An abnormal walking gait can also be a sign of the condition.

    How common are knock knees?

    In the course of developing normal alignment of their lower extremities, all young children have knock knees to some degree for a period of time. At the age of 3, more than 20 percent of children have at least a 5-centimeter gap between their ankles. By the age of 7, only 1 percent of children have this gap.

    Is my child in pain?
    Usually, only severe cases of knock knees cause a child pain. If there’s pain in a severe case, it’s usually in the front (anterior) of the knee.

    How serious are knock knees?

    For the vast majority of children with knock knees (experts estimate as high as 99 percent), the condition self-corrects and normalizes by the time a child is 7 or 8. Very few cases are severe enough to need surgery.

    Do splints, braces or special shoes help correct knock knees (valgus)?

    Splints and other devices aren’t usually needed for a child at a natural stage of valgus up to age 7. These devices can be useful if the child’s natural valgus doesn’t straighten out on its own by about the time she’s 7 or 8 years old—or if the valgus has an underlying systemic or metabolic condition causing it.                                                                              

    Who’s at risk for developing knock knees?

    • Overweight children can be at risk for developing knock knees, because their growing bones and joints have trouble supporting their weight, and as a result they tend to lean inward.
    • The condition is slightly more common in girls than boys.

    How does a doctor diagnose knock knees?
    Knock knees are obvious when a child stands with her legs straight and her toes pointed forward. Your child’s doctor can determine the severity of knock knees by observing the position of her legs, knees and ankles, and by measuring the distance between her inner ankle bones—the greater the distance between the ankles, the more severe the condition.

    If your child is within the normal age for knock knees and has no functional problems, Children’s doctors don’t usually take x-rays, in order to avoid unnecessary radiation. But if a child is older than the expected age range—or if her legs aren’t symmetrical—our doctors usually order standing x-rays.

    How does Children’s treat knock knees?
    Doctors treat most children who have knock knees with close observation during the years when a natural (physiologic) valgus is expected, since the condition usually corrects itself. As a child grows, normal or near-normal walking patterns typically resume by 7 to 8 years old, or occasionally by the time the child becomes a teen.

    In a very few cases, the valgus may be severe and may not self-correct. For children with severe, unresolved knock knees, doctors may recommend:

    • a night brace, particularly if a family history of knock knees exists; the brace attaches to a shoe and pulls the knee up into a straight position
    • orthopedic shoes, which usually have a heel wedge and sometimes an arch pad

    In the rare event that natural growth, braces or shoes don’t correct your child’s knock knees, her doctor may recommend surgery.

    Are there consequences for severe cases that go untreated?

    Severe knock knees may restrict a child's physical activities. She may not be able to run easily, putting some sports or other physical activities out of reach. If her knock knees persist into adolescence, she may become self-conscious about her appearance.

    Will my child be OK?

    This condition has a very good prognosis. Unless there’s an underlying systemic or metabolic condition associated with your child’s knock knees, her condition should correct itself as she grows, reaching normalcy or near-normalcy by the time she’s 7 or 8 years old.

    Does Children’s do research on lower-extremity developmental conditions?

    The clinical and basic science researchers in Children’s Orthopedic Centerare recognized throughout the world for their achievements in the field, including groundbreaking studies of the lower extremities. Our breakthroughs mean that we can provide your child with the most innovative care available.

    For more on Children’s extensive orthopedic research, see Research & Innovation.

    FAQ

    Q: What are knock knees?
    A:
    Knock knees are angular deformities at the knee, in which the head of the deformity points inward. A standing child whose knees touch, but whose ankles don’t, usually has knock knees. During early childhood, knock knees are a part of normal growth and development. The condition tends to become apparent when a child is 2 to 3 years old, and become more severe until about age 4. It usually self-corrects by the time a child is about 7 or 8 years old.

    Q: If my child has knock knees, will she be OK?
    A:
    Knock knees has a very good prognosis. Unless there’s an underlying systemic or metabolic condition associated with a child’s knock knees, her knees typically correct themselves as she grows, becoming normal or near-normal by the time she’s 7 or 8 years old.

    Q: What are the signs and symptoms of knock knees?

    A: A child whose ankles can’t touch when she stands with her knees touching probably has knock knees. An abnormal walking gait can also be a sign of the condition.

    Q: How are knock knees usually diagnosed?
    A:
    Knock knees are obvious when a child stands with her legs straight and her toes pointed forward. Your child’s doctor can determine the severity of your child’s knock knees by observing the position of her legs, knees and ankles, and by measuring the distance between her inner ankle bones—the greater the distance between the ankles, the more severe the condition.

    If your child is within the normal age for knock knees, has a normal exam and no functional problems, Children’s doctors don’t usually take x-rays, preferring to avoid unnecessary radiation. But if a child is older than the expected age range, or if her legs aren’t symmetrical, our doctors usually opt for standing x-rays.

    Q: How does Children’s treat knock knees?
    A:

    • close observation for most cases
    • rarely, braces and special shoes
    • surgery for severe cases that don’t resolve on their own or

    Q: If my child has knock knees, 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 knee(s)?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to her tissues or blood vessels?
    • Does my child need treatment? Does she need surgery?
    • Will knock knees affect her growth plate or the normal growth of her leg?
    • Could there be long-term effects? Pain? Arthritis?
    • Could this condition affect my child’s ability to walk, run or play sports?
    • How long should my child be followed by her care team?

    Is my child in pain?
    Usually, only severe cases of knock knees cause a child pain. If there’s pain in a severe case, it’s usually in the front (anterior) of the knee.

    Q: If my child has only one knocked knee, can she develop it in the other knee, too?
    A:
    Knock knees usually develop symmetrically in both knees. But the condition can develop on just one side, particularly if there’s been an injury to the growth area of one shin bone (tibia).

    Q: If my child has knock knees, is she at risk for arthritis or other conditions later in life?
    A:
    For most children with natural (physiologic) knock knees, there’s no added risk of developing arthritis as a result of the condition. For children with surgically repaired knock knees caused by an underlying condition (pathologic), adulthood can bring can risks for arthritis, meniscal tears, pain or dislocation.

    Q: What are the causes and risk factors for knock knees?
    A:
    Knock knees are usually part of the normal childhood growth and development of the legs. But some cases, especially in a child 6 or older, may signal an underlying bone disease, such as osteomalacia or rickets.

    Obesity can contribute to knock knees—or can cause gait problems that mimic knock knees. While knock knees usually occur symmetrically, a single knocked knee can sometimes result from an injury to the growth area of the shin bone.

    Q: What’s the long-term outlook for a child who has knock knees?
    A:
    The long-term outlook for knock knees is very positive. The condition usually corrects itself during a child’s growth years, and the child’s bone alignment is usually normal by the time she’s 7 or 8 years old.
     

    Q: What is Children’s experience treating developmental bone problems in children and teens?
    A:
    At Children’s, we’re known for our clinical innovations, breakthrough research and leadership in treatment for bone problems in the lower extremities. Children’s Orthopedic Center offers the most advanced diagnostics and treatments—several of which were pioneered and developed by Children’s researchers and clinicians.

    Causes

    Knock knees are usually part of normal childhood growth and development. But some cases, especially in a child 6 or older, may signal an underlying bone disease, such as rickets or osteomalacia.

    Obesity can contribute to knock knees—or can cause gait (walking) problems that look like knock knees. While the knees usually knock symmetrically, a single knocked knee can sometimes result from an injury to the growth area of the tibia.

    Signs and symptoms

    A standing child whose knees touch, but whose ankles can’t also touch at the same time, is usually said to have knock knees. An abnormal walking gait can also be a sign of knock knees.

    When to seek medical advice

    Contact your child’s doctor if:

    • she walks with an abnormal gait
    • her ankles can’t touch when her knees do
    • she runs with her legs swinging out
    • her knees knock together when she’s walking
    • she’s having trouble with walking or running in sports or everyday activities

    Questions to ask your doctor

    If your child is diagnosed with knock knees, you may feel a bit worried. 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 knee(s)?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to her tissues or blood vessels?
    • Does my child need treatment? Does she need surgery?
    • Will knock knees affect her growth plate or the normal growth of her leg?
    • Could there be long-term effects? Pain? Arthritis?
    • Could this condition affect my child’s ability to walk, run or play sports?
    • How long should my child be followed by her care team?

    Who’s at risk

    • Most cases of knock knees occur sporadically (by chance), with no clear reason.
    • Knock knees do tend to run in families, suggesting a genetic connection.
    • Knock knees are slightly more common in girls than boys.
    • Obesity can contribute to a child developing knock knees.

    Complications

    Surgery for knock knees is uncommon, because most of the time the condition goes away on its own. But if your child’s case is unusually severe and needs surgery, the vast majority of such procedures at Children’s are successful, and occur without major complications. After surgery, patients are at a very small risk for infection, bleeding or poor bone healing (malunion).

    For parents

    At Children’s, we make it a point to emphasize to parents that most children with knock knees have normal development. There’s a virtually 99 percent chance that your child’s knees will straighten out on their own by the time she’s 7 or 8 years old. Your child’s doctors are thoroughly experienced in diagnosing, observing and treating this condition, regardless of how severe your child’s case may be. So you can have confidence that your child is receiving the best care that our Orthopedic Center has to offer.

    Long-term outlook

    The long-term outlook for this condition is very positive. Most cases of knock knees correct themselves during a child’s growth years, becoming normal or near-normal by age 7 or 8.

    Knock knees glossary

    • anterior: front
       
    • arthritis: jointinflammation and damage, resulting in pain, swelling, stiffness and limited movement. Arthritis can occur when a joint’s cushioning cartilage wears away. Knock knees that have straightened on their own naturally don’t usually lead to arthritis; but children with surgically repaired knock knees caused by an underlying condition can be at risk for arthritis
       
    • The Center for Families at 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
       
    • guided-growth procedure: a surgical procedure for severe cases of knock knees, in which the surgeon manipulates areas of the growth plates to bring about straightening
       
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
       
    • femoral or tibial osteotomy:a surgical procedure for severe cases of knock knees, in which the surgeon cuts and straightens the femur or tibia, then reattaches the bone.
       
    • femur: the thigh bone, the longest and strongest of your child’s bones; one of the bones that forms the knee joint
       
    • gait: manner of walking
       
    • knock knees: angular deformities at the knee, in which the head of the deformity points inward
       
    • lower extremities: parts of the body from the hip to the foot, including hip, thigh, ankle, leg and foot
       
    • onset (of signs or symptoms): the first appearance of signs or symptoms
       
    • 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
       
    • pathologic valgus: knock knees caused by some underlying systemic or metabolic condition, such as rickets or osteomyelitis
       
    • physiologic valgus: a temporary condition of knock knees; a stage in the normal development of a child’s leg alignment
       
    • prognosis: outlook for the future
       
    • sporadic: by chance
       
    • tibia: with the femur, one of the large, weight-bearing bones in the lower leg (below the knee)
       
    • valgus: an alignment deformity in which the angle formed by the bones on both sides of a joint points toward the body; in knock knees, the tibiofemoral angle
       
    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

    See our extensive Glossary of Orthopedic Terms.

    Our complete orthopedic team
    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.

  • Tests

    At Children’s Hospital Boston, we know that the first step to treating your child’s knock knees is to form a timely, complete and accurate diagnosis. To diagnose your child’s knock knees, the doctor will conduct a physical exam. During the exam, the doctor will take your child’s complete prenatal, birth and family medical history.

    Knock knees become apparent when a child stands with her legs straight and toes pointed forward. Your child’s doctor can determine the severity of her knock knees by observing the position of her legs, knees and ankles, and by measuring the distance between her inner ankle bones—the condition is considered more severe the wider the distance between the ankles.

    The doctor’s exam for diagnosing knock knees may include:

    • measurements of your child’s length and height
    • measurements of her weight and body mass index (BMI)
    • measurements taken of knee extensions and rotations
    • assessment of leg-lengths and leg symmetry
    • observation and assessment of her gait

    If your child is within the normal age for knock knees, has a normal exam with a typical appearance and no functional problems, Children’s doctors don’t usually take x-rays, preferring to avoid unnecessary radiation. But if she’s older than the usual age range, or if her legs aren’t symmetrical, our doctors usually opt for standing x-rays.

     Our Orthopedic Clinical Effectiveness Research Center (CERC)

    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, 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 Orthopedic Center specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

    Doctors treat most children who have knock knees with close observation during those years when this condition is a natural (physiologic) part of a child's leg development (typically ages 2 to 5), since the condition usually corrects itself with time. As a child grows, her walking patterns become normal or near-normal by 7 to 8 years of age (or occasionally by the time the child becomes a teen).

    In a very few cases, the valgus may be severe and may not self-correct. For children with severe, unresolved knock knees, doctors may recommend:

    • a night brace, particularly if a family history of knock knees exists; the brace attaches to a shoe and works by pulling the knee up into a straight position
    • orthopedic shoes, usually equipped with a heel wedge and occasionally an arch pad

    If surgery is needed
    In the rare event that natural growth, braces or shoes don't correct your child's knock knees, her doctor may recommend surgery. The surgery may involve either influencing bone growth (called a “guided growth” procedure) or cutting and straightening the thigh bone or shin bone (osteotomy of the femur or tibia).

    Guided growth surgery means stopping the growth on the bent side of the bone (for knock knees, the inside of the knee).This is often done by implanting small metal devices that tether the medial/inside part of the growth centers around the knee, allowing the lateral/outer part to grow and straighten the knee.

    Children usually have guided growth surgery when they're approaching puberty (approximately age 11 in girls and 13 in boys). This allows time for the child's bones to continue to straighten on their own during the remaining growing years. This is a minimal day-surgery procedure, with immediate weight bearing and a rapid return to sports allowed.

    Osteotomy surgery is needed for more severe deformities or after growth is finished. After surgery, your child will probably stay in the hospital for a couple of days, and be given pain medication. When she goes home, she'll need to limit her weight-bearing activities, and she may use crutches or a walker for a six to eight weeks. Physical therapy will help restore her muscle strength. She'll probably be able to resume full activities, including sports, after six months.

    Long-term outlook

    • Since knock knees are self-correcting in up to 99 percent of cases, the long-term outlook is very positive for most children with the condition.
    • For children who need surgery for severe forms of the condition, the outlook is also excellent. The procedures are quite safe—and children's bones usually heal faster and more reliably than adults'.
    • For children with surgically repaired knock knees caused by an underlying condition (pathologic valgus), adulthood can bring can risks of arthritis, meniscal tears, pain or dislocation.

    Coping and support

    At 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 theCenter for Families for all you need to know about:
     

    • getting to 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 knock knees. Will my child need surgery? When will her knees look normal? Will it affect her long term? 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, treatment (if any) and recovery. And once your child is home, we'll help you coordinate and continue the care and support she received at Children's.
       
    • parent-to-parent: Want to talk with someone whose child has been treated for knock knees? 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 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, Children's is home to many orthopedic breakthroughs.

     

    The Experience Journal

    Designed by 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.

     

  • Research & Innovation

    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 lower limb and hip problems, as well as for 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 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

    Orthopedic basic science laboratories

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

     

    Children’s Hip Program’s unique insight and expertise

    Children’s Adolescent and Young Adult Hip 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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