Medical Edge Newspaper Column

Hip Replacement in Teens is Rare, but Not Unheard Of

April 17, 2009
Dear Mayo Clinic:
My teenage niece may need a hip replacement because of a degenerative disease. I've never heard of a young person needing a hip replacement. Is this common?

Answer:
It's uncommon, but not unheard of, for a teenager to need a hip replacement. Like older people who consider hip replacement, your niece likely has exhausted other nonsurgical measures to treat the underlying disease.

For young people, any of several underlying medical conditions could be causing the pain and hip damage that might prompt hip replacement. All are uncommon. They include:

• Juvenile rheumatoid arthritis, which causes joint inflammation and damage
• Hip dysplasia, where the child is born with hips out of alignment, which can lead to severe bone degeneration
• Legg-Calve-Perthes disease, a childhood condition associated with a temporary loss of blood supply to part of the hip joint
• Osteonecrosis (bone death) of the femoral head. Many factors can cause this, including high doses of steroid medications
• Slipped capital femoral epiphysis, where the end of the femur (epiphysis) slips away from the ball of the hip joint

Here's what happens during the hip replacement procedure. The surgeon removes the diseased or damaged bone and tissue including the ball of the thighbone (femoral head) and replaces it with a ball that is made of either metal or ceramic. The ball is attached to a metal stem that fits into the thighbone. A metal socket, with an insert made out of plastic or ceramic, is placed within the pelvis to replace the damaged socket. The new hip parts work together like a normal hip joint.

The good news for your niece is that hip replacement surgery is very effective at reducing pain. The major concern with total hip replacement in the young patient is the durability of the hip. Younger patients are more active and may wear out the hip replacement faster than older patients. Active people may need another hip replacement in 15 or 20 years.

Newer implants and improved surgical techniques may prove to be beneficial in the young patient group. Hip replacement surgery, which has been performed since the late 1960s, is successful more than 90 percent of the time.

Post surgery, your niece will increase her activities as tolerated. At six to eight weeks after surgery, she should be back doing most normal daily activities. After surgery, she may be comfortable with low-impact activities such as walking, swimming, and biking, too.

— Rafael Sierra, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.