Hip disorder in children and teenagers to be investigated by London orthopaedic team
Up to 80 children and teenagers with a serious hip disorder are to take part in a new study being run by a London orthopaedic team which could lead to the condition being better understood and more effectively treated.
The condition, avascular necrosis of the hip (AVN), is caused by a loss of blood supply to the head of the femur, as a result of congential hip dislocation, systemic disorders, or a side effect of cancer treatment. The bone tissue dies, and the bone disintegrates, often leaving the child with a limp, and in considerable pain, and at risk of developing osteoarthritis at a young age. In most severe cases some children need a hip fusion in their teenager years or a hip replacement as young adults.
Now a team led by Dr Andreas Roposch, honorary reader in clinical epidemiology and surgery at the UCL Institute of Child Health, and consultant orthopaedic surgeon at the Great Ormond Street Hospital for Children, has been awarded two years funding of almost £67,000 from the Arthritis Research Campaign to find out what AVN really means for the affected child, in terms of daily living activities and quality of life.
“AVN is a complication of many localised childhood hip disorders such as hip dysplasia in newborn babies, after they have had the hip in a harness or a cast, or after they have had hip surgery,” explained Dr Roposch. “It’s the adverse outcome everyone always fears.
Children with AVN are under long-term follow-up and they often require surgical treatment. A decision on whether to operate is usually based on the findings of x-rays (radiographs). However, radiographic findings do not directly correlate with how the affected patients feel about their well-being and their affected hip.
“Although AVN shows up on x-rays, the spectrum of symptoms is wide, ranging- from no symptoms to severe pain and disability, and we don’t understand the association between deterioration of the hip as seen in x-rays and a child’s ability to move about in everyday life. But understanding this relationship is very important when discussing treatment options of AVN with parents.”
Treatment of AVN is currently not particularly effective, while surgery, either osteotomy (reshaping the bone to reduce stress on the effected area) or a hip replacement sometimes need to be performed in more severe cases.
As part of the study, children with AVN seen at Great Ormond Street will have an x-ray and clinical assessment by a research physiotherapist, using a recently developed disease-specific measure of hip function. Participants will also be asked to fill in several questionnaires measuring health status, quality of life, and physical function.
The study builds on Dr Roposch’s previous research findings, and is another step in a programme of research to find out the best treatment in childhood hip disorders in the medium and longer term.
“AVN remains a major problem following treatment of childhood hip disorders, and can lead to chronic musculoskeletal illness and physical disability requiring costly treatment including rehabilitation and repeated operations,” added Dr Roposch.
“There is a clear need to understand what AVN really means for the affected child in order to determine whether treatment is warranted and whether it is successful. The National Institute for Clinical Excellence (NICE) recommends the use of health status measures, such as the ones we are using in our research.
“With the information that will be generated from this study, we will be able to appropriately target treatment for children with AVN.”
