The hip joint is a complex structure, critical to an individual’s lifelong mobility. Appropriate and timely treatment of simple and complex joint problems can help to maintain hip function and delay or even prevent the need for joint replacement later in life. The Froedtert & the Medical College of Wisconsin Hip Preservation Program provides optimal treatment options for the full spectrum of hip joint dysfunction and disease.
“We have the ability to treat multiple pre-arthritic hip conditions, including hip dysplasia and impingement, in a comprehensive, multidisciplinary team-based approach. This gives us an array of treatment options, including nonsurgical, minimally invasive procedures, and more complex open surgeries,” said Joseph Schwab, MD, orthopaedic surgeon, hip specialist and MCW faculty member. “We emphasize hip preservation by treating conditions early to prevent or delay the onset of arthritis, which might otherwise lead to the need for joint replacement.”
Addressing Problems With All the Moving Parts
The many parts of the hip joint — a bony ball and socket, cartilage, ligaments that hold it together and muscles that stabilize and move the hip — make it subject to a wide range of overuse injuries as well as more complex issues. The multidisciplinary team of hip orthopaedists and rehabilitation experts in the Hip Preservation Program addresses disorders that include:
- Developmental hip dysplasia
- Femoroacetabular impingement (FAI)
- Labral injuries
- Femoral rotational/torsional abnormalities
- Adult problems from childhood hip disease, such as Perthes disease and slipped capital femoral epiphysis (SCFE)
- Arthritis and arthrosis
- Cartilage injuries
- Osteonecrosis or avascular necrosis (AVN)
- Soft tissue diseases (tendon tears, bursitis, tendonitis)
- Synoproliferative disorders, such as pigmented villonodular synovitis (PVNS) and synovial chondromatosis
Dr. Schwab stressed the importance of intervening early with hip problems. “Femoroacetabular impingement, for instance, is a common diagnosis where seemingly minor abnormalities of the hip joint present with pain,” he said “Combined with the activities that young people do, it puts people at risk for developing arthritis at an early age.”
Other conditions are less related to the way the skeleton develops or grows and instead involve the blood supply to the joint.
“For reasons we don’t always understand, the blood supply gets interrupted, sometimes temporarily, sometimes permanently,” Dr. Schwab said. “If the blood supply is truly interrupted, the ball of the joint will collapse, and the joint will need replacement. We’ve been able to intervene early with a number of patients to delay or prevent that collapse from occurring.”
Strategies include medical management and a minimally invasive surgical procedure called core decompression that entails relieving pressure inside the ball to stimulate blood flow along with stem cell grafts.
Specialists Dedicated to the Hip
The Hip Preservation Program builds on advancements within the orthopaedics field itself. Previously, hip problems were treated by multiple orthopaedic specialists, but hip treatment has emerged as its own discipline in recent years.
“We have a dedicated group of surgeons focused on understanding the hip better and providing more comprehensive surgical options,” Dr. Schwab said.
At the Froedtert & MCW health network, that includes four orthopaedic surgeons and two advanced practice providers specializing in surgical treatments of the hip.
“One of the things that makes our program unique is that we also have an engaged and dedicated group of nonoperative medical providers who provide a wide array of rehabilitative and procedural treatments when appropriate,” Dr. Schwab said. That group includes six physicians who provide care across the Froedtert & MCW health network, from West Bend to Oak Creek.
Access to the Full Array of Care
Hip patients can enter the Froedtert & MCW health network at any point and gain access to the full array of specialized treatment, and several options are available for referral.
“If a physician in the community wants to refer a patient to a specific provider, that can be accomplished,” Dr. Schwab said. “If a community physician is seeing a patient with hip pain and wants help figuring it out and sorting through a diagnosis, we have the ability to connect them with multiple providers to initiate treatment.”
Another advantage of the Hip Preservation Program is that patients who see any one of the providers have the potential of getting an opinion from all the providers.
“Every month, all of our providers get together to review the patients we’ve seen,” Dr. Schwab said. “If a physician sees a new patient and wants a group opinion, they can present the case, get the group’s recommendation and then connect the patient to the right specialist.”
Referring physicians can also choose a virtual option that has been instituted since COVID-19, which can be especially beneficial if the patient is coming from a long distance. During a virtual visit, the referring doctor discusses the patient’s history, reviews any imaging and details treatments to date. The consultation may suggest other treatments or physical therapy to try before recommending the patient come in person, with a follow-up conference scheduled in about six weeks.
Whether patients come to the Froedtert & MCW Hip Preservation Program via direct referral or virtual visit, they will benefit from comprehensive expertise and providers unlike any other in the region. “What makes us unique is the ability to deliver the right care to the right patient,” Dr. Schwab said.
For Our Referring Physicians:
Academic Advantage of Our Hip Preservation Program
The Froedtert & MCW health network gives patients and their referring physicians a distinct advantage.
Contact our physician liaison team for more information about the Hip Preservation Program or if you would be interested in meeting with any of the hip preservation team members.