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Wednesday, January 30, 2008

Off-Loading Young Hips

It is no secret that obesity is a substantial driver of any hip and knee replacement program. Although all kinds of factors can promote degenerative joint disease, the excess weight bearing down on a given joint certainly doesn't help.

In adults, this is pretty much accepted and as there is no end to the obesity epidemic in sight, orthopedic surgeons are unlikely to be out of work anytime soon.

But now, there is increasing evidence that obesity may be driving an increase in joint problems in kids.

Slipped capital femoral epiphysis (SCFE), typically appearing around the time of the early-pubertal growth spurt in adolescents (twice as often in boys than in girls), is of growing concern.

In a recent article, Murray and Wilson from the Royal Hospital for Sick Children in Edinburg describe a 2.5-fold increase in SCFE in Scotland over the last two decades, but also that SCFE was now increasingly seen at younger ages. This increase remarkably parallels the substantial increase in childhood obesity in Scotland over this time period.

Typically patients present with a history of several weeks or months of hip or knee pain and an intermittent limp. Treatment requires surgical fixation of the femoral head to avoid further slippage.

With all the concern about increasing type 2 diabetes, dyslipidemia and hypertension in kids, let's not forget bone and joint health.

Missing the diagnosis can lead to irreversable damage with loss of function. Early recognition and surgical treatment (with or without weight loss) is essential.


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