If she hadn’t decided to move to San Diego, she may not have been diagnosed
As a young girl, Kristen S. loved to spend her free time rock-climbing, playing basketball and ice skating—all the markers of a happy, healthy childhood. Yet, she was not quite like the other children. When she ran, her foot turned out and her hip clicked, but with her childhood ebullience, she kept going.
But at 15, the clicking in her hips became more severe and she began experiencing tremendous pain in the front and side of her hip, and groin area. Soon, she was sidelined from her favorite sports. An MRI didn’t show any signs of problems.
“Everything I loved to do I couldn’t anymore,” Kristen recalled. “There is nothing more disheartening as a teenager than not being able to keep up with my peers in PE because I couldn’t bend over far enough to reach my toes or do crunches—and the doctors could not find anything wrong with me; they thought it was all in my head.”
At 18, Kristen moved from Phoenix to San Diego to attend San Diego State University. Soon after her move, her pain increased and her hips started locking up more resulting in periods of immobility. “Unlike most kids my age, I couldn’t even sit with my legs out in front me or touch my toes,” Kristen said.
She said that one day, she woke up with sharp shooting pain up and down her left leg so severe she collapsed on the floor. “I laid there for three hours until my roommate came home.”
Kristen visited the SDSU Health Center and the orthopedist there referred her to Dr. Harish Hosalkar, a renowned Southern California specialist in pediatric, adolescent and adult hip preservation and reconstruction, deformity correction, limb reconstruction, and orthopedic trauma.
Dr. Hosalkar diagnosed a massive symptomatic labral tear in her left hip. The labrum is a fibrocartilage rim that surrounds the hip joint and gives it stability. This cartilage seals the joint, deepens the socket and protects the joint by decreasing external impact to the joint. A tear to the labrum causes tremendous pain and athletic people are particularly susceptible to this injury.
“After Dr. Hosalkar identified the problem, I broke down in tears. Finally, after so many years of not being believed, I had a diagnosis,” she said. She also was diagnosed with an underlying structural abnormality of the hip—femoroacetabular impingement (FAI)—which contributed to the labral tear.
The hip joint is one of the body’s largest weight-bearing joints and is the point where the thigh bone and the pelvis joint. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movements of the joint.
In Kristen’s case, her hip socket was extra deep causing pinching (pincer) of the ball, leading to secondary bump formation (cam) on the ball, so that it would no longer fit appropriately into the hip socket and causing abutment or impingement in motion.
“The treatment options for management of hip disorders in young patients have been limited,” Dr. Hosalkar said. “However, the newer minimally invasive techniques for hip joint preservation, have been found to be beneficial in these patients and also help avoid early arthritis with the need for total hip replacement.”
Five months after her diagnosis, Kristen underwent hip preservation surgery with Dr. Hosalkar at Paradise Valley Hospital in the South Bay. As part of the procedure, her labrum repaired completely, socket edge was appropriately trimmed down (rim-trim) and the bump on the ball was shaved and sculptured down to prevent any conflict in the motion of the joint.
“Now, I can touch my toes; I can run a mile!” the college student enthused, six months’ post-surgery. “I feel like I was given a new hinge in my body just for bending!”
Kristen, who is studying to be an environmental engineer, accomplished her goal of being able to drive again by her 21st birthday. She is now focused on increasing her flexibility.
“Hip preservation helps preserve the natural hip joint for several years or decades and resolves a variety of painful hip conditions,” Dr. Hosalkar said. “Many of my patients, even in extreme symptoms such as Kristen, are able to return to activities that they were unable to do for years because of pain and limited range of motion.”
“My unspoken goal was to one day have a baby, which I never thought my body could handle,” she acknowledged. “Now, I think there’s a real chance!”