From OT Europe

Treatment of hip disorders in children

EFORT

Orthopaedic problems in the pediatric population are common. These problems are either congenital, developmental or acquired. In the case of the hip joint, pain and impaired function can be caused by a broad spectrum of conditions and accurate diagnosis requires careful examination of the patient and his/her clinical history. Indeed, hip anatomy in children is unique due to the presence of a growth plate under the femoral head and due to the influence of growth and its vascularity and biomechanics.

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As children are in constant change, the long-term results of any surgical treatment in their hip joints are crucial and pediatric practitioners always have to consider the “time” as an additional parameter for any decision-making. Appropriate treatment is chosen in each particular child depending on age and comorbidities, but also according to the trends seen in the profession.

It is hard and rather complex to predict the next big trend in any human activity. In the medical field, trend is the direction in which a specialty develops. It could be considered as the phase before any diagnostic or treatment procedure becomes evidence-based medicine. Among all medical fields, orthopaedic surgery has a long track record of being sensitive to trends.

Indeed, generally speaking, we are currently witnessing a certain evolution of orthopaedic health care linked to trendy terms, such as patient-specific treatment, robotics and computer-assisted surgery, biomaterials, tissue engineering, 3-D printed implants, augmented reality and artificial intelligence. It is therefore important to understand how these trends are being used in the pediatric field. Do these represent a benefit for the patients? As an example, artificial intelligence already has a significant role in image interpretation, structure finding, as well as in extracting the correct values of some “big data” pools (eg, in research, where augmented reality can help the clinician to deliver care). Maybe, in the future, the correct algorithms of artificial intelligence will serve to avoid misinterpretation of clinical data and better uncover subtle signs and symptoms in rare diseases.

The Interactive Expert Exchange session on hip disorders in children to be presented during the upcoming EFORT Congress in Lisbon will provide up-to-date insight into constantly changing trends in pediatric orthopaedics.

Thursday 6 June 2019 | 10:00 to 12:15
Paediatric Hip Disorders – New Trends?

Introduction & Conclusions
Darko Anticevic (Croatia)

Presentations & Questions

  • To be “in trend” or not to be? | Darko Anticevic (Croatia)
  • Arthroscopy for sequelae of SCFE and Perthes disease of the hip | Manoj Ramachandran (United Kingdom)
  • Adolescent hip dysplasia and role of PAO | Jaroslaw Czubak (Poland)
  • Congenital and metabolic disorders: What is the role of hip reconstruction? | Deborah Eastwood (United Kingdom)
  • Cystic lesions of femoral neck | Pierre Journeau (France)

Clinical Cases - Discussion
Provocateurs: Melinda Witbreuk (Netherlands) & Manuel Cassiano Neves (Portugal)

As far as hip joint mobility and functionality are concerned, children have a faster postoperative recovery and usually show less pain after surgery. Moreover, conservative treatments for hip diseases in children are less effective, despite being less stressful. Surgery is therefore the treatment of choice for many conditions, such as slipped capital femoral epiphysis or SCFE, Perthes disease or for hip reconstruction in congenital and metabolic disorders, although long-term outcomes still depend on the challenge of growth, also called the fourth dimension of pediatric care. For instance, dealing with a growing hip reinforces the importance of choosing well between an osteotomy, which can change the biomechanics or axis of an already altered joint, and a less invasive procedure, such as arthroscopy. Nevertheless, arthroscopy is an approach more suitable for cartilage treatment and soft-tissue joint conditions. Therefore, the most favorable condition for success is the establishment of a correct diagnosis at the youngest age possible and in the absence of comorbidities (eg, neuromuscular or genetic disorders and conditions leading to weakness of bones, such as osteogenesis imperfecta or tumors). Alternatively, new technologies could globally influence well-established procedures, as these are less invasive, cause less pain and ensure a faster and healthier return home after hospital stay.

Speakers in this Interactive Expert Exchange panel are well-known collaborators from EPOS, the European Paediatric Orthopaedic Society. During this session, they will discuss the indications and outcomes of techniques they use on a daily basis to treat several hip disorders, as well as give their personal hints on how to select the right type of treatment for each patient. The program of the session will highlight the decisive factors to recognize the orthopaedic trends that will become classic procedures. Debate will focus on which treatment is suitable for which diagnosis and at what stage of anatomic development a specific technique should be used. Finally, together with the audience, each trend presented will be analyzed for any potential benefit it has for the patient.

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The format of this exchange, including lectures, open debates and case presentations, will lead to in-depth evaluation of all the possibilities for pediatric surgeons when faced with children with common hip diseases. Highly experienced surgeons in the specialty of pediatric hip management will discuss pros and cons of each technique to help the attendees’ decision-making.

As of this year, the Interactive Expert Exchange sessions can be attended by any participant fully-registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting will be available on our registration platform as of January 2019. Join the session and challenge the experts.

EFORT

Orthopaedic problems in the pediatric population are common. These problems are either congenital, developmental or acquired. In the case of the hip joint, pain and impaired function can be caused by a broad spectrum of conditions and accurate diagnosis requires careful examination of the patient and his/her clinical history. Indeed, hip anatomy in children is unique due to the presence of a growth plate under the femoral head and due to the influence of growth and its vascularity and biomechanics.

Lisbon Banner

As children are in constant change, the long-term results of any surgical treatment in their hip joints are crucial and pediatric practitioners always have to consider the “time” as an additional parameter for any decision-making. Appropriate treatment is chosen in each particular child depending on age and comorbidities, but also according to the trends seen in the profession.

It is hard and rather complex to predict the next big trend in any human activity. In the medical field, trend is the direction in which a specialty develops. It could be considered as the phase before any diagnostic or treatment procedure becomes evidence-based medicine. Among all medical fields, orthopaedic surgery has a long track record of being sensitive to trends.

Indeed, generally speaking, we are currently witnessing a certain evolution of orthopaedic health care linked to trendy terms, such as patient-specific treatment, robotics and computer-assisted surgery, biomaterials, tissue engineering, 3-D printed implants, augmented reality and artificial intelligence. It is therefore important to understand how these trends are being used in the pediatric field. Do these represent a benefit for the patients? As an example, artificial intelligence already has a significant role in image interpretation, structure finding, as well as in extracting the correct values of some “big data” pools (eg, in research, where augmented reality can help the clinician to deliver care). Maybe, in the future, the correct algorithms of artificial intelligence will serve to avoid misinterpretation of clinical data and better uncover subtle signs and symptoms in rare diseases.

The Interactive Expert Exchange session on hip disorders in children to be presented during the upcoming EFORT Congress in Lisbon will provide up-to-date insight into constantly changing trends in pediatric orthopaedics.

Thursday 6 June 2019 | 10:00 to 12:15
Paediatric Hip Disorders – New Trends?

Introduction & Conclusions
Darko Anticevic (Croatia)

Presentations & Questions

  • To be “in trend” or not to be? | Darko Anticevic (Croatia)
  • Arthroscopy for sequelae of SCFE and Perthes disease of the hip | Manoj Ramachandran (United Kingdom)
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  • Adolescent hip dysplasia and role of PAO | Jaroslaw Czubak (Poland)
  • Congenital and metabolic disorders: What is the role of hip reconstruction? | Deborah Eastwood (United Kingdom)
  • Cystic lesions of femoral neck | Pierre Journeau (France)

Clinical Cases - Discussion
Provocateurs: Melinda Witbreuk (Netherlands) & Manuel Cassiano Neves (Portugal)

As far as hip joint mobility and functionality are concerned, children have a faster postoperative recovery and usually show less pain after surgery. Moreover, conservative treatments for hip diseases in children are less effective, despite being less stressful. Surgery is therefore the treatment of choice for many conditions, such as slipped capital femoral epiphysis or SCFE, Perthes disease or for hip reconstruction in congenital and metabolic disorders, although long-term outcomes still depend on the challenge of growth, also called the fourth dimension of pediatric care. For instance, dealing with a growing hip reinforces the importance of choosing well between an osteotomy, which can change the biomechanics or axis of an already altered joint, and a less invasive procedure, such as arthroscopy. Nevertheless, arthroscopy is an approach more suitable for cartilage treatment and soft-tissue joint conditions. Therefore, the most favorable condition for success is the establishment of a correct diagnosis at the youngest age possible and in the absence of comorbidities (eg, neuromuscular or genetic disorders and conditions leading to weakness of bones, such as osteogenesis imperfecta or tumors). Alternatively, new technologies could globally influence well-established procedures, as these are less invasive, cause less pain and ensure a faster and healthier return home after hospital stay.

Speakers in this Interactive Expert Exchange panel are well-known collaborators from EPOS, the European Paediatric Orthopaedic Society. During this session, they will discuss the indications and outcomes of techniques they use on a daily basis to treat several hip disorders, as well as give their personal hints on how to select the right type of treatment for each patient. The program of the session will highlight the decisive factors to recognize the orthopaedic trends that will become classic procedures. Debate will focus on which treatment is suitable for which diagnosis and at what stage of anatomic development a specific technique should be used. Finally, together with the audience, each trend presented will be analyzed for any potential benefit it has for the patient.

IEE banner

The format of this exchange, including lectures, open debates and case presentations, will lead to in-depth evaluation of all the possibilities for pediatric surgeons when faced with children with common hip diseases. Highly experienced surgeons in the specialty of pediatric hip management will discuss pros and cons of each technique to help the attendees’ decision-making.

PAGE BREAK

As of this year, the Interactive Expert Exchange sessions can be attended by any participant fully-registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting will be available on our registration platform as of January 2019. Join the session and challenge the experts.