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World-Renowned Hip Care

World-Renowned Hip Care

by | May 3, 2022 | General News, Hip Disorders

Scottish Rite for Children’s Center for Excellence in Hip has a long tradition of providing the highest-quality medical care to thousands of children, from newborns to adolescents and young adults. Led by director and pediatric orthopedic surgeon Harry Kim, M.D., M.S., the team provides a coordinated and comprehensive approach to care that brings together hip specialists from orthopedics, radiology, physical therapy, psychology and more. This multidisciplinary team approach allows us to offer a broad spectrum of operative and nonoperative care options to preserve, improve and repair the native hip joint. At the Forefront of Innovation  Our experts are committed to advancing clinically important research to provide the best care to our patients. Several of the center’s research projects have led to revolutionary, life-changing results. Patients who had evaluation and treatment at our center have the opportunity to participate in large patient registries to allow for evaluation of treatment outcomes for a variety of conditions. These studies lead to new insight and significant improvement as our team modifies treatment algorithms based on these results. In addition, doctors and researchers are involved in multicenter hip research groups with peers at top-tier institutions around the country. They regularly collaborate to discuss the latest innovations and treatment techniques regarding patients diagnosed with pediatric hip conditions and injuries. Movement Science Laboratory The accredited movement science laboratory is an integral part of the treatment of our patients. The multidisciplinary team of engineers and kinesiologists use leading-edge technology to evaluate and identify joint motion, net joint forces, muscle activity, strength, foot plantar pressures and oxygen consumption. These analyses guide the development of individualized treatment plans for our patients and support research. The clinical research team partners with movement science to study the changes experienced with surgical intervention to ensure each patient continues to maintain improved hip functions. Multidisciplinary Complex Hip Clinic This clinic brings all of our hip experts together in one clinic to review and evaluate each patient in person together. The history, physical examination and images are evaluated, and various options are discussed for treatment. The multidisciplinary approach also includes experts in the fields of physical therapy, psychology, pain management and nursing. A comprehensive diagnostic (if necessary) and treatment plan is then developed specifically for each patient. If surgical treatment is necessary, the full range of procedures are available with the experts in the field to include hip preservation surgery (both open and arthroscopic options) as well as the potential for utilizing total hip arthroplasty (replacement) when appropriate. This clinic occurs every month and only those patients requiring this multidisciplinary approach are included. Patients may request to be seen in this clinic. Hip Team All of our pediatric orthopedic surgeons are board certified in orthopedic surgery and also completed a fellowship in pediatric orthopedics. Several of our medical staff have a particular interest in treating and studying pediatric and adolescent hip conditions. Harry Kim, M.D., M.S. 
  • Special interest in treating patients with Perthes disease, adolescent and young adult avascular necrosis, and developmental dysplasia of the hip (a member of International Hip Dysplasia Institute).
  • Leader and chair of the International Perthes Study Group – multicenter research study focused on advancing the care of children diagnosed with Perthes disease.
  • Extensive basic and clinical research on Perthes disease and avascular necrosis.
Daniel J. Sucato, M.D., M.S. 
  • Special interest in treating adolescent patients with various hip conditions including hip dysplasia, adolescents and young adults with Perthes disease, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study. A multi-center project that analyzes hip function and pain, quality of life and other factors on patients who undergo hip preservation surgeries.
Henry B. Ellis, M.D. 
  • Special interest in treating femoral acetabular impingement, labral tears and other sport-related injuries and conditions in the hip.
  • Involved in multi-center research projects with a special interest in hip arthroscopy.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
David A. Podeszwa, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
William Z. Morris, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • Extensive clinical research in the pediatric and adolescent developing hip with expertise in the pathogenesis of slipped capital femoral epiphysis and femoroacetabular impingement.
Corey S. Gill, M.D. 
  • Special interest in treating infants with hip dysplasia and patients with cerebral palsy with various hip disorders/dysplasia.
  • Other common hip conditions seen include slipped capital femoral epiphysis, Perthes disease, transient synovitis of the hip, osteoid osteoma and proximal femur cysts.
Learn more about the Center for Excellence in Hip.
Study of Patient-reported Outcomes of Legg-Calvé-Perthes Leads to Greater Mental Health Awareness for Healing Children

Study of Patient-reported Outcomes of Legg-Calvé-Perthes Leads to Greater Mental Health Awareness for Healing Children

by | Jan 6, 2022 | Sports Medicine

A new study of Legg-Calvé-Perthes disease on patients’ mental health at Scottish Rite for Children led to helpful insights for pediatric orthopedic care for the condition and an award for UTSouthwestern medical student Angel Valencia.

Training with Harry Kim, M.D., M.S., the director of the Center for Excellence in Hip, Valencia was awarded the PROMIS® Health Organization Trainee Poster Award for his work analyzing data from PROMIS® Health Organization’s patient-reported outcomes measurement information system (PROMIS®), which allows patients to evaluate and monitor their physical, mental and social health.

TEXAS SCOTTISH BITE HOSPITAL. A man with glasses and a bow tie is wearing a white coat that says texas scottish rite hospital

Kim is a founding member and Chair of the International Perthes Study Group (IPSG), a group of more than 50 pediatric orthopedic surgeons and researchers from 16 different countries dedicated to improving the care of patients with Perthes disease. “Although there are still uncertainties with the condition, we have made significant strides in advancing the clinical research and treatment,” says Kim.

The study shed light on patients’ quality of life following Legg-Calvé-Perthes disease, one of the most common childhood hip disorders that can result in significant hip deformity and early-onset osteoarthritis. These findings will allow clinicians to identify at-risk patients who would most benefit from mental health resources before developing significant depressive symptoms or anxiety. This study also shows the need for further work in identifying other risk factors for adverse mental health outcomes and evaluating current practices of psychological support.

In a healthy hip joint, the ball of the joint, or the round femoral head of the femur, fits perfectly into the round socket of the pelvis. Perthes disease interrupts the flow of blood to the femoral head causing all or part of it to die. When osteonecrosis, or bone death, occurs, it results in the ball breaking or deforming under pressure from normal rigorous childhood activities. Patients generally heal without surgical intervention, but the process can be slow. If the femoral head remains misshapen, long-term issues like pain and stiffness can arise.

Valencia retrospectively analyzed 62 patients aged 11 years or older in the healed stage of Perthes disease who reported on their physical mobility, pain interference, fatigue, anxiety, depressive symptoms and peer relationships at the time of their visit. The results showed a significant correlation between the degree of femoral head deformity and patient-reported mental health. As patients’ mobility decreased, their fatigue, pain interference, anxiety and depressive symptoms increased. “This study highlighted the wealth of knowledge that patients can impart on clinicians to improve their care with the use of patient-reported outcome measures,” Valencia says. “By utilizing these measures and addressing patient psychosocial needs in their treatment, clinicians will have a greater perspective to provide patient care at a more comprehensive level.”

Interestingly, the study did not show a considerable correlation between femoral head deformity and peer relationships. “This is likely due to the variability of social support systems and interests of patients,” Valencia says. “For example, a severely deformed femoral head in a child who likes to engage in many sports activities with their friends may respond differently than a child who enjoys socializing with computer-related activities that do not require as much movement and loading on the hips.”

Valencia is proud of this achievement and the work he and the researchers at Scottish Rite for Children are doing. “I cannot overstate what an honor it has been working with Dr. Kim and the rest of the Perthes team at Scottish Rite, and I look forward to continuing our research in Perthes patient-reported outcome measures,” he says.

Checking In – Perthes Disease

Checking In – Perthes Disease

by | Mar 25, 2021 | Hip Disorders

Checking In – A Scottish Rite for Children Podcast, Episode 4
Perthes Disease

Host: Clinical Nurse Manager, Jennifer Bowden, R.N.
Expert Guests: Director of the Center for Excellence in Hip and pediatric orthopedic surgeon Harry Kim, M.D., M.S., and special guest Kristen Odom, R.N.

Listen to the full episode.
Below are the highlights from this episode:

What is Perthes disease?

Perthes disease is a pediatric hip disorder that usually affects children between the ages of 2 and 14.  The cause of this condition is currently unknown. Perthes disease leads to a loss of blood flow to the hip joint; however, experts do not know why that blood flow is disrupted.

What are some important terms that parents should always be aware of or understand when talking about this condition?
Perthes disease affects the hip. The hip joint includes a ball (femoral head) and socket (acetabulum). Perthes affects the ball part of the hip, causing a disruption and loss of blood supply, which initiates the disease. This leads to necrosis, or death of the bone. A common term used when talking about Perthes is osteonecrosis – osteo=bone and necrosis=death, meaning bone death.

What are the different stages of Perthes disease? 

There are four stages to the disease.

  • The first stage is when the blood flow gets disrupted, also known as necrosis – the stage of bone death.
  • The second stage is fragmentation which is when the body tries to heal the bone, but the ball (femoral head) is weakened, causing it to break down. Because the body is also trying to remove the dead bone, the head starts to collapse or flatten out, which causes it to lose its round shape.
  • The third stage is re-ossification which is when the body begins to remove the dead bone and start to build back the new bone.
    • Re-ossification: 
      • Re: is the starting back
      • -ossi: is the bone
      • -fication: is the new remaking of the bone
  • The fourth stage of Perthes disease occurs when the hip joint is all healed, also known as the healed stage.

What are the symptoms of Perthes disease? 

  • Persistent limping.
  • Pain in the hip, knee or thigh.
  • Stiffness in the hip and/or decrease in range of motion.

How is Perthes diagnosed? 

The diagnosis of Perthes requires determining that the cause of pain is not due to other issues or another condition. A thorough history is taken to make sure it is not something else, and then an examination is done to assess the hip as well as the knee to make sure it is the hip that’s the problem. The diagnosis of Perthes requires X-rays because it’s not just a clinical diagnosis. Diagnostic imaging is required.

For older children, patients over the age of 6, our team usually orders a specific MRI called a perfusion MRI. This test can assess how severe the disease is and provides more clarification on if operative treatment would be beneficial/necessary for the child.

What makes the perfusion MRI an important part of diagnosing Perthes disease?

The perfusion MRI involves injecting MRI contrast into the hip so that the blood flow can be analyzed to better understand where blood flow is lacking. More loss of blood flow means that the disease is more severe, and the healing process can take longer.

Why is it important to be seen by a pediatric orthopedic specialist for Perthes?

Perthes disease is a very uncommon condition that few doctors have experience in diagnosing and treating. It is important for parents to find a pediatric orthopedic specialist with a special interest in Perthes disease that cares for children with the condition regularly.

What can a parent and patient expect when they come to Scottish Rite to be seen for Perthes? 

The team at Scottish Rite provides a comprehensive assessment of the child – thorough history and physical exam, required imaging and reviewing any previous X-rays or testing that has been done previously.

The child’s emotional state is also assessed. They are asked to complete a PROMIS questionnaire which asks the child about anxiety, depressive symptoms and their peer relationship, as well as psychological aspects of the patient. Perthes is a chronic condition meaning the treatment can take months and, for some, years to overcome. Our team provides care for the whole child – mind, body and spirit.

What are the treatment options for Perthes disease?

All children are different, as is the severity of each child’s condition, so the treatment plan created for each child diagnosed with Perthes is also unique. Our team evaluates each patient – the stage of the disease they are in, range of motion and pain – then develops an individualized treatment plan.

Non-Operative Treatment

  • Weighted relief treatment – the child is given crutches, a walker or wheelchair to decrease the amount of weight placed on the hip.
  • Petrie casting – a treatment started back in the 1970s which involves putting both legs in the cast with a bar or two bars in between to spread the legs. This allows the hip to rest, especially for the children who are very active and unable to rest themselves.

Operative Treatment
Depending on the child and severity of their condition, surgery is an option to treat Perthes.

International Perthes Study Group
Scottish Rite for Children is the leading center for the International Perthes Study Group (IPSG). IPSG includes over 50 pediatric orthopedic surgeons and researchers from 10 different countries who are dedicated to improving the care of patients with Perthes disease.

The research from this group analyzes the very basic scientific level of the condition to better understand the disease and the key processes that are contributing to the femoral head collapsing and not healing properly. Through that research, the team is trying to develop new and innovative treatments to improve healing for children diagnosed with Perthes.

Learn more about the International Perthes Study Group.