Melanie Cole (Host): Welcome to Healing Heroes, PDX. The podcast series from the specialists at Shriners Hospitals for Children in Portland. I'm Melanie Cole and today we're discussing the hip specialty program at Shriner's Hospital. Joining me is Dr. Dominique Laron. He's a Pediatric Orthopedic Surgeon with Shriners Hospitals for Children in Portland. Dr. Laron, it's a pleasure to have you join us today. So let's start with kind of a little working definition of the types of hip deformities that can occur and how common they are.

Dr. Dominique Laron (Guest): Well, I think it's important to note that hip deformities can come in all types of flavors and we can see them in all types of ages as well. So when we talk about a hip deformity program here at Shriner's Hospital for Children in Portland, this is a very wide umbrella term. So we see things ranging from congenital and developmental dysplasia of the hip in newborns to cerebral palsy, hip disorders. So essentially we can take care of kids from just born to up to young adulthood for a very wide array of different disorders and issues.

Host: Well, then tell us about some of the patients that you work with. Dr. Laron, you mentioned the wide array of the ages that you work with. How old are they typically and what is the presentation? What are the symptoms that parents would look out for things that they would notice? Things that a pediatrician would notice? What are we looking for?

Dr. Laron: In some of our really early young kids, we see developmental dysplasia of the hip, which is a management problem of the hip being developed and grown atypically in utero. And that's essentially just a shallow acetabulum or the socket of the ball and socket joint of the hip that can present early as if in the United States, kids have certain risk factors such as being the first born or being in the breach position. They're usually screened with an ultrasound and can be picked up by a pediatrician and a physical examination and been referred out here for specialty care. And in those cases, we treat them early often with an noninvasive harnessing and bracing. And then if they're not caught later on, this can involve more intensive interventions, surgical interventions with close reductions, and then sometimes every so often. And hopefully rarely with these surveillance programs, we have to do bigger reconstructive hip surgeries in the walking hip dysplasia.

Now, as far as our other population, which we're somewhat famously known, taking care of here at Shriner's Hospital for Children in our cerebral palsy and neuromuscular had disorders, there's a tone issue. So it's not a growth problem that the socket has developed abnormally, but muscle tone has caused these hips to either subluxate, which just means they're kind of migrating out or even frankly, dislocate, which if not treated, can lead to hip pain and disorders in which the child can't sit or walk properly. And we can take care of those, of all types of soft tissue tone management. We have really comprehensive program here with neurologists and Botox injections and some soft tissue lengthening’s. And then every so often with our more involved kids, we have to do large hip reconstructive surgeries, which we also do

Host: Well, thank you for telling us what parents might expect and what type of care of patients with these discrepancies might receive, and even what surgical interventions a family might expect. So what advice Doctor do you have for parents who have children with these conditions that you're discussing? What do you want them to know about the future and their children and their healthy hips?

Dr. Laron: As we're talking about big swath of different things with our developmental dysplasia population, if we get them early, often these nonsurgical interventions can avoid any type of large surgery in the future. And while we monitor them as they grow, getting to that early is the biggest key. So if you notice anything abnormal about your child, either a leg length discrepancy, or abnormal folds or anything that might be of concern to your pediatrician as well, it's definitely important to get them checked out. And then for our cerebral palsy and neuromuscular population, I find that those parents tend to be pretty well educated, as kids with these issues and diagnoses tend to, you know, need different kinds of care. So I would just say getting plugged into a place like Shriner's Portland, where you have competent care and all things, neurology, surgical bracing, and whatnot is just an important thing. So my advice for parents with kids with these conditions is just to be really involved and have, you know, as many people see them as they can be taken care of for

Host: Well, that's so important for parents to hear and the Portland Shriners Hospital specializes in pediatric orthopedics. Obviously how important is it that a family seeks out the specialists when it comes to their child's hip condition? Speak about this multidisciplinary care. You've mentioned a few types of providers speak about why that's so important.

Dr. Laron: I think it's just important to get specialists involved early and often because pediatric orthopedics is pretty much all that we do here at Portland Shriners. Everyone in this group has had extensive specialized training in these disorders, so we know how to deal with it. And while many people from a surgical standpoint could probably deal with just the pure surgery and approaches. It really is a kind of holistic whole body, whole child care. And so preoperative tone management and physical therapy, speech therapy, occupational therapy, especially in our neuromuscular and cerebral palsy population is very important for both preoperative management, operative management, and then postoperative rehab. And just really taking our kids who are ambulatory and them as ambulatory as possible for as long as possible. And then our kids who tend to be, non-ambulatory just making them as comfortable as possible. And really our goal as a group and as a hospital is just to let your child doing as great and as wonderful as they are. And we just want to let kids be kids. And that's really our overall goal. So having a specialist involved in their care is I would say it's vitally important and able to get the best care for these disorders.

Host: Then Doctor, what does the treatment plan look like for children with these types of disorders? What does it look like when they get there and how does it work for the family?

Dr. Laron: Well, we're a specialized pediatric orthopedic group. So we see far more hip disorders and probably your standard clinics and outpatient primary care physicians. And as we see kids for the first time we interact with them on multiple levels. So we have our radiology department here that has state of the art, 3D, low dosage radiation. And then the first time we meet, I try not to sign anyone up for surgery right away, but really just want to optimize anything that we can do that is noninvasive. So that looks a lot like the first intake meeting you see, you're started on a program right away with our physical therapist, speech therapist, occupational therapist. And then we also have access to a Motion Lab here, which allows for ambulatory kids with hip disorders, see exactly what their muscles are doing with their joints are doing in space, all on a three dimensional computerized model to really dial in any type of intervention we might be able to do and monitor them from a preoperative and postoperative standpoint. And then for our kids are appropriate for bracing, for hip disorders and helping them emulate. We have that all onsite with one of the best orthotics and prosthetics departments I've ever been around. So it's really just wraparound care and collaboration that starts the first day you come in.

Host: That's so cool. So another thing that we're learning right now about video visits, telehealth, Shriners Hospitals for Children in Portland recently launched Fast Track Video visits. It's a telehealth program that allows patients to receive their medical care from the comfort of their own home. Does this apply to patients who are receiving care for hip deformities and how do you feel that you've been creative and thought out of the box during the pandemic to help kids with these disorders?

Dr. Laron: I think it's just important to note this COVID-19 Pandemic has really touched pretty much everyone and hasn't left anyone unaffected. And so it's been hard and there's been a lot of difficulties with it, but I would say that one positive thing to come out of this is it really kind of forced medical health providers and kind of systems in general, to see how we can leverage both technology and just technology in general, to limit exposures, to hospitals and decrease risk to patients and providers. You can imagine the safest way to have someone not be exposed to a hospital is just not to have them come in. So we've been able to leverage, you know, Skype video visits in an encrypted form to see patients at home. A lot of this is difficult for things that you need to really see for physical examinations, but in the setting of some hip disorders like developmental dysplasia of the hip, for example, we're really just monitoring ultrasounds and making sure these harnesses that kids were putting in, fit.

So, I have a couple patients who are down in the Medford regions, which is a five plus hour drive, to have them drive up, to come in, to just check a fit and go over an ultrasound is onerous at best and impossible at worst. So to be able to leverage a Skype video visit check in on the child instead of having them come up here on a weekly basis, you can do it every three weeks and do the other visits via virtual visit. And then as far as some of my summer acetabular impingement population in which I've done hip arthroscopy, and I'm really just checking in to see how you're doing, how your incisions are healing postoperatively and how physical therapy is going. We can kind of leverage the video visits to just check a range of motion in the hip really quickly. And obviously we can't do it as an extensive of a physical examination to see exactly what we want, but it can really decrease the need for families and patients to come in, which is hopefully easier for them from both a logistics and convenience standpoint, but also allows them to not have to be exposed to the hospital

Host: So important right now. And are there any innovations in the field of treating hip disorders that you want to tell us about Dr. Laron?

Dr. Laron: I think there have been a lot in both the imaging modalities and treatments, hip arthroscopy is becoming kind of a more accepted treatment plan for some of these things that kind of were thrown away as just hip pain in children. I think looking back at, I guess, taking our adult population and looking at some of the hip replacements that we're doing in 50, 60 and 70 year olds, kind of looking back, I don't know through the crystal ball, if you will, we're seeing that this might just be underdiagnosed, hip dysplasia or femoroacetabular impingement, which is just a mismatch from the femur femoral head and the acetabulum of the pelvis. So looking back, we're seeing that these might have been well treated as children or young adults with either hip arthroscopy or realignment procedures, like very acetabular osteotomies, which is just fancy speak for realigning the socket within the pelvis itself. And we do all that here at Shriner's Hospital in Portland, we've been able to utilize MRIs and our 3D dimensional imaging in our eosystem, which is a low radiation, comprehensive, not like a CT scan, but with much less radiation to the child to really see how the bones are aligning within the pelvis and within the hips and by using all this new data or just creating programs to give better care early and intervene earlier. And when it's possibly too late, when children are having pain or three to changes in their young adulthood or later on in life,

Host: It is such an interesting topic, Dr. Laron, as we wrap up, give your best advice to parents out there who might notice something with their children or hip disorders and what you'd like them to know about the care that you offer at Shriners Hospitals for Children in Portland?

Dr. Laron: I would just say, and I say this, all the parents that I meet, you know, I spend a half hour an hour with you, but you're with your child every single day. And this is one of, if not the most precious thing that you have in your life, depending on how many children you have. So I would just say as the most knowledgeable person about that parent's life, if you see or notice something different about the way they walk or what they're doing, no child should have a limp. That's normal. Our goal is to have a kid be his kid. If they're usually out in playing, if they're usually out and active and something's different about that, I definitely just would advise them to come in. There's no matter too small or something that should be overlooked. And even if it's so, you know, the way their hips turn in, when they sit, which you might think is nothing, we're happy to see them here at Shriners Portland to even just give you reassurance that what they're doing and how they sit and how they walk and how they run is completely normal. And if that's something else there we're happy to intervene earlier, as we've kind of seen and discussed that early intervention can really make a big difference in the lifetime of a child.

Host: Thank you so much, Dr. Laron for sharing your expertise on this very important topic. Thank you again for joining us. And that concludes this episode of Healing Heroes, PDX with Shriners Hospital for Children in Portland. To learn more, please visit us online at portlandshrinershospital.org, or you can call (503) 221-3422 for more information, and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Shriners Hospitals for Children in Portland podcasts. I'm Melanie Cole. Thanks for listening.