Total Hip Replacement in Adolescents

Total hip replacement (also known as total hip arthroplasty) is a surgical procedure that replaces a painful, damaged hip with a prosthetic joint. The goal of total hip replacement is to improve patients’ mobility, function, and quality of life. It’s an option for people with end-stage joint damage that has not improved with other treatments.

Hip replacement implant technology has improved significantly in the last two decades, and studies have shown that most adolescents and young adults who have total hip replacements with modern implants do not need revision surgery to replace their implants for 15 years or more. However, the chances of requiring one or more revision surgeries later in life are still significant. Patients and families should carefully weigh their options and decide whether the potential for increased mobility, independence, and freedom from pain is worth the possibility of additional surgeries in the future.

To understand total hip replacement, it helps to understand the structure of the hip joint, which is a ball-and-socket joint made up of:

• The acetabulum, a socket in the pelvic bone
• The femoral head, a ball-shaped bone at the top of the femur (thighbone) that fits into the socket
• Cartilage that protects the acetabulum and femoral head from rubbing against each other

Every time you take a step, sit down, cross your legs, or stand up, the femoral heads in your hips rotate inside your acetabula (hip sockets). If a femoral head is misshapen, or if the cartilage that lines the joint is damaged, the bones start to rub together and become increasingly painful.

During total hip replacement surgery, a surgeon removes the damaged bone and replaces it with prosthetic components. This involves:

• Removing the femoral head and inserting a metal stem into the femur
• Attaching a ball (usually ceramic) to the top of the metal stem
• Removing the damaged cartilage and surface of the acetabulum and replacing it with a metal socket. The socket will have a special plastic or ceramic liner to prevent the ball from rubbing directly against the socket.

Most total hip replacements are non-cemented, which means the implant is held in place by growth of the surrounding bone onto the implant. Patients with weak or deformed bones may require the use of bone cement for implant fixation.

Orthopedic surgeons typically recommend delaying total hip replacement until a patient is middle aged or older to increase the chance that the prosthetic hip will last for the rest of their life.

Most pediatric hip conditions are treated successfully with conservative treatment or traditional hip preservation surgeries, including periacetabular osteotomy (PAO), femoral osteotomies, surgical hip dislocation, and hip arthroscopy. In young patients, such techniques are always considered first. When hip pain continues to limit an adolescent or young adult’s daily activities like walking and going to school, possibly forcing them to rely on a walker or wheelchair for mobility, total hip replacement may be considered.

Although rare, the conditions below can sometimes progress to the point that total hip replacement may be an option:

• Legg-Calve-Perthes disease
• Slipped capital femoral epiphysis
• Hip dysplasia
• Juvenile idiopathic arthritis
• Vascular malformation
• Multiple epiphyseal dysplasia
• Sequela of septic arthritis or fracture
• Pigmented villonodular synovitis, also known as tenosynovial giant cell tumor
• Avascular necrosis of the femoral head as result of cancer treatment or trauma

Your child’s recovery from total hip replacement depends on several factors, including the stability of the bone around the hip joint, any co-occurring conditions, and the complexity of the surgery.

In most cases, patients go home the next day after surgery. If your child has a complex hip condition or a heart or lung condition, they may need to stay in the hospital longer.

Your child’s care team may encourage your child to get up and walk on their new hip soon after surgery — movement promotes circulation and can prevent the hip from becoming stiff. Your child may need to walk with a cane or a walker at first to avoid falling until they regain their balance.

Your child can take a shower but, to prevent infection, should not take a bath or go swimming until the surgical incision has fully healed. This usually takes about four weeks.

Your child’s doctor will talk with you about when your child can safely play sports or engage in other activities. In general:

• Low-impact sports like walking, cycling, and golf tend to be safe after total hip replacement surgery.
• Swimming is a safe low-impact sport, however, your child should wait until their surgical incision has fully healed.
• High-impact and contact sports like running, football, soccer, skiing, tennis, and weight lifting can cause more wear and tear and reduce the durability of the prosthetic joint.

Most adolescent and young adult patients experience major improvements, including less pain, greater range of motion, increased function, and improved quality of life after total hip replacement.

Modern implants can last 20 or more years, however, many factors come into play, such as the surgeon’s experience and the patient’s age, weight, and activity level. More experienced surgeons tend to have the most success in reducing their patients’ pain, enabling their patients’ to return to activity, and ensuring the longevity of the hips they implant.

Boston Children’s Child and Young Adult Hip Preservation Program team includes surgeons with extensive experience in hip preservation surgery and total hip replacement in both adolescents and adults.

As pediatric surgeons, we recognize that total hip replacement in young patients poses unique challenges, including low bone density, small bones, and structural hip differences. As part of pre-surgical planning, our surgeons will work closely with you, your child, and each other to determine the best surgical approach for your child based on their overall health, preferred activities, and goals.

As a pediatric hospital, we provide an environment where patients of any age feel free to ask questions and feel comfortable with the treatment they receive.