ENDURING HIP MANAGEMENT: ADOLESCENT TO AGED

Abstract

Orthopaedic treatment of upper and lower extremities has traditionally been attended by specialists in specific areas of expertise; arthroscopy, biologic reconstruction, total joint replacement. In many specialty centers of the US and worldwide, procedures performed by specialists do not consistently coincide with subspecialty training. This is particularly true for hip surgery, where a majority of total hip arthroplasty (THA) procedures are performed by Orthopaedists that undertake less that 50 fifty such procedures annually.

With advances in knowledge and technique, surgical hip treatments have significantly progressed in recent decades. By all estimates, there is a need for specialized surgical treatment in this area, as the demand for hip replacement and revision is likely to far outpace that of population growth in the coming decades. Discreet categories of replacement versus preservation have become less clear, thus paving the way for an emerging specialty of exclusive hip surgery. The scope of such surgery encompasses an age span from the adolescent at skeletal maturity to elderly. Advances in hip arthroscopy have improved outcomes for young patients. Progressive data and knowledge have fueled biologic non-arthroplasty solutions in the hip such as osteotomy and surgical hip dislocation for femoral acetabular impingement. Development of limited replacement options such as resurfacing have also broadened the spectrum of treatments and added to the level of complexity in hip surgery. Total hip arthroplasty and revision numbers continue to climb annually. Combining preservation procedures with options for replacement and resurfacing, the hip specialty creates a continuum of medical care that may redefine the joint care paradigm.