The hips are formed at the same time as most of the skeleton: during the embryonic period of life. On some occasions, the ball and socket fail to develop properly. This can lead to an abnormal shape of ball, an abnormal shape of socket or even no socket at all. This can cause differences in leg length and often compromises function. It is often noted early in life and paediatric orthopaedic surgeons can be invoved in operations to help the shape of the socket or the ball. Hips with dysplasia often wear out earlier and may need hip replacement at young ages. Mr. Miles is experienced in hip replacement for dysplasia in patients from teenage years onwards and will consider special techniques to improve the position, including specialised implants, custom implants and leg length operations.
Perthes disease is a condition where the blood supply to the very top of the thigh bone (the femoral head part of the hip joint) is lost and the bone becomes soft and crumbly. It presents in childhood with limping and can be treated by paediatric speicalist orthopaedic surgeons. Slipped capital femoral epiphysis (SCFE) is a relatively similar problem where the upper part of the femur slips off, through a growth plate in the femoral head. It can result in similar problems in the long term. In adulthood, even after successful treatment as a child, the femoral head shape is often not perfect and it can lead to arthritis of the hip. This usually begins with pain, followed by a loss of function. If arthritis is significant, it may lead to the need for a hip replacement at a very young age. Mr Miles would perform this using an uncemented hip and typically will use ceramic bearings. These are very hard wearing and have the potentially to last for a very long time.
There are a multitude of conditions that can affect the formation of bones and joints, many of which are quite rare. As Mr Miles works at a specialist centre, he looks after many patients with these rarer conditions regularly and has developed strategies to deal with some of the more challenging aspects of their surgery. He has particular experience in dealing with patients with achondroplasia, pseudoachondroplasia and epiphyseal dysplasia, often choosing to use customised cutting techniqes or implants for their care to be delivered to the highest standard possible.