Although it sounds like it has more to do with those in their teens or early 20s, the area of 'Young Adult Hip Conditions' refers to an orthepaedic speciality for people with hip problems ranging from adolescents to those in their 40s. There are several reasons for the emergence of this sub-speciality:
1. Differential diagnosis
To distingish it from those of an older age whose hip problems may well be more likely to be down to age-related changes in the hip joint, such as osteo-arthritis (OA). Hip related pain in young adults can be due to a huge variety of different aetiologies, morpholgies, pathologies and minor abnormalities, and some of these can overlap. Some of them are soft-tissue related, some are due to auto-immune conditions, some are due to malignancy or more serious pathologies and some are from residual paediatric hip or lower-limb conditions. It requires an understanding of the differential diagnoses around the hip, groin, pelvis and lumbar spine. Clinicians (including physios and surgeons) who have more experience in this area will be more likely to have an awareness of these different things.
2. Early intervention
Clinicians seeing young adults with hip-related pain are often dealing with conditions where the morphology of the hip joint is importatnd to be aware of. For example CAM, Pincer, or other types of Femoro-Acetabular Impingement, Dysplasia and the sequelae of other paediatric conditions such as Legg-Calve-Perthes and SUFE (Slipped Upper Femoral Epiphysis). Some of these conditions pre-dispose the hip joint to early development of OA. This means that differential diagnosis and ruling out such conditions with accurately reported radiographic imaging needs to happen sooner rather than later if physio is proving ineffective. It seems that some of these conditions are difficult to differentiate from each other without x-ray imaging.
3. Hip preservation surgery
Hip preservation surgery, for example, hip arthroscopy, pelvic osteotomy (PAO) and femoral osteotomy are surgeries which have a steep learning curve for surgeons. They are very technically difficult surgeries and those who are specialised and perfom them in high volumes are usually best placed to achieve good outcomes.
4. Hip Replacement (THR)
For those presenting with degenerative hip disease in young to mid-adulthood and having a hip replacement, there is more chance they will need at least one revision hip replacement in their lifetime, so this isn't a case of knocking the prosthesis in any old how and hoping for the best. There is greater pressure on the surgeon to perform a hip replacement that will last. Where the OA is secondary to abnormal morphology of the acetabulum and/or femoral head, this again, requires more technical skills and pre-operative planning. For example, a dysplastic acetabulum may be located or facing in a particular way, and even after previous osteotomies it is not the same as a normal hip joint. So, precise 3-dimensional measurements and a custom-made prosthesis might be needed. There may also be tissue scarring, metalwork and denser bone in some areas due to previous surgeries, making inserting an artificial prosthesis more challenging. All these things, again, require greater technical skill and pre-operative planning on the part of the surgeon. It requires differing skills to those performing THRs in older adults.
5. Different life stage
As well as all these other things, young adults are at a different stage of life compared to older adults. They have family, children and work commitments which are that much more disrupted by their own pain, disability and recovery from surgery, both in a practical and relational sense. Younger adults will also have different expectations in terms of their long term recovery and goals; they may want to return to higher levels of activity than those of an older age.
In Part 2 of this post I explore some reasoning around this area.
Reference:
Image obtained from: www.manchesterhipclinic.com
