Long-Term Impacts

 
VII.C.13
 

Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

An estimated 25,000 patients were seen in  hospitals and emergency departments in 2013 for treatment of developmental dysplasia (DDH) of the hip.1 While DDH can often be successfully treated in childhood, it is now understood that even with successful treatment, residual effects can have a huge impact on the musculoskeletal burden of osteoarthritis in adulthood. One in four people are likely to develop symptomatic hip osteoarthritis in their lifetime.2  Thus, total hip arthroplasty is one of the most common musculoskeletal surgeries performed in the United States, with 343.6 thousand procedures performed in 2013.3 It is now also recognized that the underlying etiology of hip arthritis is often related to childhood developmental hip conditions such as Developmental Dysplasia of the Hip, Legg Calves Perthes disease, and Slipped Capital Femoral Epiphysis.4 A United States study of patients less than 50 years of age noted radiographic findings of developmental dysplasia of the hip in 23%.5. Long term outcome studies of surgeries to treat residual hip dysplasia in adults shows 74% native hip survival at 18 years.6 This long term impact of developmental hip conditions and the ability of hip hip preservation surgeries to prevent or delay onset of arthritis underscore the importance of early diagnosis and long term follow up into adulthood.

Other conditions commonly thought of as only affecting children, such as cerebral palsy, osteogenesis imperfecta, and spina bifida, are now being seen more than ever in adults thanks to the tremendous progress in care leading to longer life expectancy. Remarkably, some people with Duchenne’s muscular dystrophy are now surviving into early adulthood. Concomitant with this success has come a host of new issues concerning the transition of care to adulthood and the aging process.

Adults with these conditions are disproportionately affected by the aging process. Some issues are clear. For example, those with mobility challenges have difficulty participating in fitness regimens, leading to more sedentary lifestyles and secondary issues such as obesity, diabetes, and heart disease. Other issues are less clear. Adults with aftereffects of childhood musculoskeletal disorders have more difficulty accessing preventative care. Even more subtle are issues related to lack of providers skilled in treating adults with the sequela of childhood issues and psychosocial challenges.

The medical community needs to investigate whether the needs of patients are being met and if they are reaching full potential as productive adults. The margin of function which allows individuals to live independently is often very small. Early or more pronounced reduction in function associated with aging may make the difference in whether a care giver is required for activities of daily living or there is independent living.

Research into the Health-Related Quality of Life, prevalence of disease, potential to avoid disease, and availability of care, including preventative care, is required.

  • 1. ICD-9-CM code 754.3 (subluxation and dislocation) and 835 (recurrenc).
  • 2. Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18(11):1372-13779. Doi: 10.1016/j.joca.2010.08.005. Epub 2010 Aug 14.
  • 3. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Fourth Edition, 2020. Rosemont, IL. Arthritis: Joint Disease: Arthritis in Patient Populations: Joint Pain and Joint Replacement. Accessed March 16, 2020.
  • 4. Aronson, AAOS Instructional Course Lecture 35:119-128, 1986
  • 5. Clohisy JC, Dobson MA, Robison JF, et al. Radiographic structural abnormalities associated with premature, natural hip-joint failure. J Bone Joint Surg Am 2011;93(Suppl 2):3–9.
  • 6. Wells J, Millis M, Kim YJ, et al. Survivorship of the Bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res 2017; 475(2): 396-405. http://dx.doi.org/10.1007/s11999-016-4903-3.

Edition: 

  • Fourth Edition

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