Growth modulation of the hips

Growth modulation of the hips is also sometimes called ‘proximal femoral hemi-epiphysiodesis’.

Why is growth modulation of the hips necessary?

Children who have difficulty standing and walking are at increased risk of hip problems. The hip joint is made up of a ball and a socket. Reduced standing and walking can lead to the shape of the hip developing differently, increasing the risk of the ball moving from under the socket. If this happens, it can lead to problems with function and pain.

When to consider growth modulation?

The shape of the hip joint can be improved with hip reconstruction surgery. In some children, growth modulation can be considered before the bigger reconstructive surgery is needed. Part of the problem with the ball moving from under the socket is due to the shape of the top of the thigh bone.

If your child is quite young and their hips are showing early changes, growth modulation may be considered. The aim is to slow down the change in your child’s hip position to try and delay the need for hip reconstruction surgery.

How does the operation help?

Part of the problem with the ball moving from under the socket is due to the shape of the top of the thigh bone. At the top of the thigh bone, there is a growth plate where your child’s bone grows from. If growth can be stopped on one side of the growth plate, it can change how the bone grows. This can help with the shape of the top of the thigh bone and the hip position.

What happens during the operation?

This operation is done under general anaesthetic, meaning your child will be asleep. A cut will be made on the outside of the leg. A screw will be positioned at the top of your child’s thigh bone across one half of the growth plate to stop the growth on one side.

This operation can often be done alongside another operation to help with tight muscles in the groin. Your consultant will discuss this with you if they think it will be helpful. For more information on this, visit adductor lengthening surgery.

What should I expect after the operation?

Your child might be able to go home the same day, but they may need to stay overnight.

There is no need for any casting unless this operation has been done at the same time as another operation, which your consultant will have spoken to you about if needed.

Standing and walking

Your child can put weight through their legs following this operation and can return to their normal activities as comfort allows.

Therapy

The therapy team will see your child in hospital after their operation. They will go through exercises, positive positions and things you can do to help your child get the most from their surgery.

Exercises will need to be done a minimum of 3 times a day. Your local physiotherapist will guide your child’s rehabilitation journey, however it is your responsibility to make sure they complete the necessary exercises.

The therapy team at the hospital will speak to your child’s local physiotherapist requesting they see them after discharge and will pass on any important information.

Your child can access hydrotherapy if it is available once the wounds are healed. The wounds should be healed within 2 weeks of the operation.

Follow-up

Your child will continue to be followed-up in the orthopaedic clinic. It is important that we continue to monitor the position of the hips. Over time as your child grows, the screw may no longer cross the growth plate. When this happens, the screw is no longer doing it’d job. If this happens, your consultant will discuss the options. They may consider taking the screw out and putting a new one in.

Summary points

• Growth modulation may not improve the position of your child’s hips, the aim is to prevent them getting worse or slow down how quickly they change.
• The screw will need removing at some point.
• Your child is still at risk of hip displacement after the operation, and you should continue to help them protect their body shape.
• Your child can return to their normal activities following this operation as soon as they are comfortable to do so.