This operation allows preserving the natural anatomy of the hip joint and avoiding early joint osteoarthritis and early endoprosthetics in the future, according to a press release from Santaros Clinics.
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“Femoral head epiphysiolysis is a condition where the femoral head separates from the femoral neck through the growth plate and begins to slip from its usual position. In children, this process often occurs gradually – the femoral head can slip for months. There are cases when the displacement of the femoral head – epiphysiolysis – happens suddenly due to trauma. This process is accompanied by pain, and the child’s gait changes,” explains Julija Ravinskienė, pediatric orthopedic traumatologist at the Children’s Surgery, Orthopedics, and Traumatology Center of Santaros Clinics.
The problem may lie somewhere other than where it hurts
The femoral head is connected to the femur by the growth plate – a cartilaginous area through which the bone lengthens as it grows. This area is weaker than the surrounding bone, so during growth and puberty, when this zone “softens,” the femoral head may begin to slip in some children.
Femoral head epiphysiolysis is usually not related to a specific trauma. It often develops during a child’s growth spurt. One of the main risk groups is overweight children. The disease is most commonly diagnosed in children aged 11–14 years.
According to the doctor, one of the biggest problems is that the pain is not always felt in the hip area. This often misleads both parents and doctors: “Pain usually starts in the knee joint or thigh, not the hip or groin itself. Therefore, sometimes the child and parents go a long way before the true cause of the pain is diagnosed: the knee joint is examined, X-rays and MRI scans are performed, rehabilitation is prescribed, but the child’s complaints do not end. The child limps, begins to turn the leg outward, and the gait changes,” says orthopedic traumatologist J. Ravinskienė.
Therefore, the doctor emphasizes a simple but very important rule: if a child has knee pain, the hip joint must also be checked: “When diagnosing femoral head epiphysiolysis, assessing hip movements is important, and X-ray examination is the main diagnostic method,” says the orthopedic traumatologist.
Children who are overweight have a higher risk of femoral head epiphysiolysis, and a small separate risk group includes those with certain endocrine and metabolic diseases. This condition can occur in both boys and girls.
When stopping the disease is not enough
Once femoral head epiphysiolysis is diagnosed, surgical treatment is required to fix the femoral head. The goal of the surgery is to stop further slipping.
However, when the femoral head has slipped significantly, fixation alone is not enough. Due to the resulting deformity, normal hip joint biomechanics are impaired, so it needs to be restored: “When the deformity is greater, the position of the femoral head no longer corresponds to the anatomy of the hip joint. Joint movements are disturbed, the deformity mechanically damages the cartilage and other joint parts (the labrum). This causes pain and leads to very early hip joint wear, developing osteoarthritis,” explains Dr. J. Ravinskienė. “In such cases, the femoral head must be restored to the correct position and fixed. This way, we aim to preserve the hip joint.”
Patient’s mother: “Everyone thought it was growing pains”
The family of a patient from Panevėžys took about two months to reach the correct diagnosis. At first, no one suspected that the increasing leg pain concealed a serious hip joint problem.
“At first, it seemed nothing very serious. The pain would come and go. Since my daughter was active and played sports, we thought it might be growing pains or a muscle or tendon problem. But the pain did not go away. It especially worsened after winter, when she had COVID and flu at the same time. The pain was not constant – it would intensify and then subside. She slept well at night. These circumstances caused concern because the cause of the pain was unclear,” says the girl’s mother, Vesta.
The family consulted several doctors about their daughter’s health. Various tests were performed to find possible causes of the pain. They were tested for infections, blood tests were done, and possible muscle or other soft tissue problems were investigated. However, there was no answer as to why the child had leg pain.
“During those two months, we visited about a dozen different doctors. We sought physiotherapy treatments. We performed various tests – their results were good. There were moments when it seemed the pain had passed. But it returned,” recalls the mother.
According to her, one reason the diagnosis took so long was that the girl was physically active – she used public transport to attend art and sports classes. At first, her complaints did not seem to indicate a serious orthopedic problem, but the pain did not go away and kept returning.
Finally, the family decided to seek answers at a private clinic. The doctor, after assessing the girl’s condition, suggested a hip joint examination: “Then it became clear that the problem was exactly there. Everything happened very quickly after that – once we knew the diagnosis, we immediately went to the hospital in Panevėžys,” says the girl’s mother.
At the Panevėžys hospital, doctors confirmed that surgery was necessary. However, after evaluating the situation, it became clear that standard treatment would not be enough – the femoral head had slipped significantly, so a more complex surgery was needed, which was decided to be performed at Santaros Clinics.
“Probably the most frightening fact was that the child would need surgery and in Vilnius. At that time, we still did not fully understand how serious it was. Only later did we realize that we were very lucky that the examination revealing the true problem was finally done,” says the girl’s mother.
For the girl herself, the hardest part was not the many tests or doctors but the increasing pain and the limitation of her usual life because of it. It became difficult for the actively sporting girl to do what she could do without restrictions before.
“She really wanted to live as before. When other children rode bicycles, she also wanted to ride. It was painful to see that she could not do it as before. Now we are happy that she is returning to her normal life – seeing a laughing child is a very good feeling,” says the mother.
For the parents, their daughter’s attitude toward the surgery was also important. Although the news about the complex treatment initially frightened her, the girl went through everything quite calmly and tried to understand what was happening to her.
Today, the family views the whole journey differently. The biggest lesson they take away is that prolonged child pain should not simply be attributed to growth or fatigue, especially if it recurs and begins to limit the child’s normal life.
“Now we understand that if we had known earlier that hip examination was necessary for leg or knee pain, the diagnosis might have been made sooner. We most want other parents not to waste so much time seeking answers, and that our daughter’s story would remind doctors that when a child has leg or knee pain, they should also consider hip joint problems,” says the girl’s mother.Bottom of Form
The girl’s parents are sincerely grateful to the entire team that operated on their daughter: “Thank you for restoring the joy of movement and preserving not only the child’s ability to move but also her life. Today, when many in society lack trust in doctors, we ended up in the hands of dedicated professionals. They gave hope and allowed us to believe that everything would be fine. We want to give special thanks to the ward nurses who, during the hardest times when we were lost and scared, provided not only physical but also immense psychological support,” the girl’s mother expresses her gratitude to the medical team.
Surgery where preserving blood flow is most important
Restoring the femoral head to the correct position is one of the more complex hip joint-preserving surgical procedures. To reach the femoral head and restore it to its physiological place, the blood vessel supplying the femoral head must be dissected and preserved. Such surgeries are performed in the world’s largest hospitals specializing in hip joint-preserving surgery.
“The essential thing is to preserve the blood flow to the femoral head. During the surgery, we must separate and protect the vessels that supply it. This is a vital procedure: if the vessel were damaged, the bone tissue would lose blood flow, die, and deform. In such a case, preserving the natural joint would no longer be possible. When restoring the femoral head to the anatomical position, we use microsurgical techniques. This is very meticulous surgery that requires excellent anatomical knowledge and precise execution of every step,” says orthopedic traumatologist J. Ravinskienė, who is especially pleased with the performed surgery.
During the approximately 3-hour surgery, the hip joint was safely dislocated, blood flow preserved, the femoral head returned to the anatomical position, and fixed with screws.
The goal – so the child will not need a hip joint prosthesis in the future
Although after such surgery the child faces a longer and more complex recovery and rehabilitation period, according to the doctor, the chosen surgical tactic has a very important long-term goal – to preserve a freely moving and painless hip joint as long as possible.
“Endoprosthetics is an effective treatment method, but a twelve-year-old child has their whole life ahead. Therefore, our goal is to preserve a freely moving and painless hip joint as long as possible,” says Dr. J. Ravinskienė.
If the significantly displaced femoral head were not treated, the deformity would very quickly mechanically damage the joint, leading to early osteoarthritis. Movements would be painful and very limited, and the child would limp. Then the only treatment left would be hip joint replacement with an endoprosthesis.
Complex surgeries – the result of teamwork
According to orthopedic traumatologist J. Ravinskienė, such surgeries are possible not only because of specific surgical techniques but also due to accumulated team experience in performing hip joint-preserving surgeries. The surgery was performed by pediatric orthopedic traumatologist Julija Ravinskienė together with department head Rimantas Zagorskis.
“Our department has been rapidly advancing in hip joint-preserving surgery in recent years. We are accumulating surgical experience and expanding our capabilities to treat increasingly complex pathologies. I am very pleased that we are already performing such surgeries in Lithuania. It is important to emphasize that such surgery is not the work of one person. Without the anesthesiologists, nurses, and postoperative care team at Santaros Clinics – nothing would be possible. This is the result of our collective work. I feel very grateful to the team for their dedication,” says orthopedic traumatologist Julija Ravinskienė.
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