On June 28, 2019, the life of Kamryn Dehn was about to change for the better. That morning, John Clohisy, MD, a Washington University physician at Barnes-Jewish Hospital, performed extensive surgery on Kamryn’s right hip, putting an end to more than 10 years of pain and suffering due to developmental dysplasia.
Developmental dysplasia? That’s a condition in which the “ball and socket” of the hip joint doesn’t properly form in babies and young children. In Kamryn’s case, she was born with a shallow hip socket (acetabulum) that didn’t fully cover the ball portion of her upper thigh bone (femur), causing the hip joint to become unstable. Instability of the hip can cause hip pain and, over time, wear out the joint and lead to arthritis of the hip.
Kamryn’s dysplasia was further complicated by a deformity of the ball of the hip joint. By the time Kamryn reached age 2, she had undergone two surgeries to her right hip, both requiring a body cast.
Though she would later learn from Dr. Clohisy that these treatments early in childhood didn’t completely correct her hip problems, Kamryn enjoyed a normal and active childhood. She walked with a slight limp due to the surgeries, but was an avid swimmer and runner.
It wasn’t until high school that she began to experience symptoms from the dysplasia, including back spasms and painful flare-ups in her hip, back and legs. Sometimes, if she walked or used her legs too much, she had trouble falling asleep because of muscle pain and aching.
As Kamryn entered her freshman year at Purdue University, her pain level had intensified. Walking around campus with a heavy backpack made her pain flare-ups unbearable. “Though at times, I became so numb to the pain that I hardly felt it at all,” she says.
During Christmas break of her sophomore year, she felt as if something was slowly tearing in her hip. For the previous couple of years, Kamryn had been bounced around from doctor to doctor. Some prescribed shoe lifts and pain medications. Others sent her to physical therapy. But all were just temporary fixes — and none of them satisfactory.
“It was frustrating because the appointments had to be scheduled months in advance. Some doctors would see me for just five minutes, tell me that they couldn’t help, and refer me to someone else. I was tired, aggravated and very much in pain,” she says. “I was also scared that I would be stuck with this affliction for the rest of my life, and here I am majoring in aquatic sciences, which requires some physicality.”
Kamryn returned to school for the spring semester on crutches and had difficulty walking for more than 20 minutes at a time. “I felt like I didn’t have the ability to walk. My legs felt as if they were detached,” she says. It was during this spring semester that an orthopedic specialist in Indianapolis referred Kamryn to Dr. Clohisy.
“I remember crying at my first appointment with Dr. Clohisy, because I was finally getting answers to all the questions I had, including a solution that gave me a lot of hope,” Kamryn says.
She was particularly impressed with how quickly Dr. Clohisy and his team diagnosed her condition, took the time to answer her questions and explain her X-rays in detail. “I really enjoyed that because I felt more included and informed.”
Dr. Clohisy’s diagnosis of Kamryn was residual hip deformity related to her childhood dysplasia. “Kamryn’s early childhood treatment of her developmental hip dysplasia did not completely correct the problem,” he says.
Kamryn’s hip deformity, Dr. Clohisy says, involved the ball and socket of her joint, which didn’t fit together properly. The socket (acetabulum) in her hip was shallow and the ball (femoral head) was more elliptical than round. This deformity was a source of her pain — an impingement where the cartilage gets pinched between the rim of the socket and femoral head.
“Even though a patient has had successful treatment in infancy or childhood, a deformity can recur or persist as the person’s body continues to grow and develop. Subsequent symptoms can occur in adolescence, young adulthood, or even later as an older adult,” Dr. Clohisy says.
“Kamryn’s condition was complicated in the sense that she had deformities of the hip socket as well as the femur. We had to decide which part of her hip needed to be corrected. Is it the socket or the femur, or is it both?
“When we first examined Kamryn, she did have a shallow hip socket,” Dr. Clohisy says. “So, we thought she would likely require a PAO (periacetabular osteotomy) surgery, where we reposition the hip socket. But a three-dimensional evaluation of her hip with a CT scan showed that the deformity on her femur was actually worse than the deformity of her socket. It revealed a very abnormal rotation of the femur bone, which represented the major part of her problem.
“These three-dimensional findings really guided our preoperative planning and, as it turned out, she did not require a PAO surgery because after the surgical correction on the femur, the hip was stable and we thought we had addressed her hip problems.”
When the surgical procedures were explained to her, Kamryn said it sounded like an uncommon mix of different corrections, to which Dr. Clohisy agreed. The surgical techniques to treat Kamryn’s hip did represent a relatively uncommon combination of techniques. The primary technique is called a “safe surgical dislocation of the hip.” This is where the hip is surgically dislocated to provide exposure to the entire acetabulum and top of the femur bone. It enabled Dr. Clohisy to repair the cartilage inside of Kamryn’s hip joint and to reshape the femoral head or ball of the hip joint to make it more spherical or round to match the hip socket.
Dr. Clohisy also lengthened the neck of the femur bone to relieve abnormal contact between the femur and the rim of the socket — a source of pain for Kamryn. At the conclusion of the procedure, the muscle attachment to the femur was advanced to a more normal position to improve her muscle function about the hip.
In addition to the surgical dislocation of the hip, Dr. Clohisy performed a de-rotation proximal femoral osteotomy, where the femur bone is cut, rotated and then fixed in a new position with a plate and screws. This was done to stabilize Kamryn’s hip and normalize her hip range of motion.
Despite the complexities of techniques performed on Kamryn’s hip, Dr. Clohisy’s team had a great deal of experience in similar hip preservation procedures. Specializing in the comprehensive treatment of developmental and acquired hip conditions in adolescents and young adults has been a long-term focus of his practice. The “Adolescent and Young Adult Hip Service” at Washington University is supported by a multidisciplinary team of clinicians and researchers, including radiologists, physical and occupational therapists, physiatrists, and basic and clinical scientists.
Kamryn doesn’t remember being in pain after her surgery, just a little sore. She is also pleasantly surprised that she hasn’t experienced any pain since her operation, considering everything that was done to her hip and leg.
“I sleep much better at night. I’m more flexible. I can do stretches that were impossible prior to my surgery. Walking and impact activities still feel odd, but that’s due to leg weakness,” she says. “I have to rebuild my outer thigh muscle over time.”
On Aug. 31, 2020, Kamryn was examined by Dr. Clohisy, who showed her the successful outcomes of the surgical techniques involved by comparing preoperative X-rays of Kamryn’s hip to X-rays taken that morning.
“Everything is excellent,” Dr. Clohisy told Kamryn. “As you can see, the ball and the socket fit well together, we repositioned the muscle further down on the femur to make it stronger and more efficient, and we created a longer neck. The deformity correction is excellent. Everything is healed. You’re doing great.”
Treating patients like Kamryn is extremely rewarding, Dr. Clohisy says. “As we apply relatively new surgical treatments, we are able to decrease pain and improve function for the majority of our patients,” he says. “We’re diagnosing hip problems early and treating them in many cases surgically to correct hip deformity, improve hip function, decrease pain and, hopefully, preserve the life of the hip over time and in doing so, prevent arthritis of the hip by surgical treatment.”
For Kamryn, the experience has definitely been for the better. “I feel great,” she says.