AANA25 Hip Access Pass-CONCURRENT SESSION 4H: Pediatric Hip: Not Just Little Adults

Video Transcription

Video Summary

The panel discusses the safety and considerations of hip arthroscopy and surgery in skeletally immature patients. Initially, they caution against performing femoroacetabular impingement (FAI) surgery when the growth plate (physis) is still open, as disrupting the periosteal ring and physis risks growth arrest or iatrogenic slip. Literature shows mixed outcomes, and many “skeletally immature” cases studied are near skeletal maturity with partially closed physes. Stabilizers like the perichondral ring contribute significantly to physeal strength. Surgeons favor waiting until substantial physeal closure before performing osteoplasty. In certain urgent cases, limited labral repair without bony work may be done. <br /><br />The discussion then focuses on slipped capital femoral epiphysis (SCFE) deformities, where hip impingement is complex due to metaphyseal bumps and rotational deformities causing cartilage damage. Mild deformities might be treated arthroscopically, but moderate and severe slips often require femoral osteotomy combined with osteoplasty for better range of motion outcomes.<br /><br />Borderline dysplastic hips in adolescent athletes pose decision challenges between hip arthroscopy and periacetabular osteotomy (PAO). Patients with true instability typically benefit from PAO, whereas those with isolated impingement and normal stability may do well with arthroscopy. Detailed imaging measures beyond lateral center edge angle, like anterior wall index and femoral version, aid in treatment planning.<br /><br />Finally, rotational osteotomies (femoral and acetabular) are explored, emphasizing individualized assessment of femoral and acetabular version abnormalities. While acetabular reorientation via PAO is often reliable, femoral and tibial rotational deformities may also require correction, especially if gait or knee symptoms arise. The group emphasizes careful patient selection, thorough imaging, and cautious surgical timing, prioritizing skeletal maturity and anatomical considerations to optimize outcomes and minimize risks.

Asset Caption

Moderator: Stephen K. Aoki, M.D.
Eduardo Novais, M.D. | Michael P. McClincy, M.D. | Travis Matheney, M.D.

Keywords

hip arthroscopy

skeletally immature patients

femoroacetabular impingement (FAI)

growth plate (physis)

physeal closure

slipped capital femoral epiphysis (SCFE)

femoral osteotomy

periacetabular osteotomy (PAO)

rotational osteotomies

skeletal maturity