By Lori Shontz, St. Louis Post-Dispatch, January 22, 2007

The first time Danielle Giessman''s leg started to hurt, the solution was simple. She stopped kickboxing.

But while searching for the source of the pain, she learned that both of her hip sockets were deformed, a condition called dysplasia. As the condition gradually worsened, the pain returned, even when she wasn''t doing anything particularly strenuous. Such as...sitting.

"It got to the point, I''d be at work and it felt like someone was stabbing me in the leg, on my right side in the groin," Giessman says. "I''d stand up real quick and try to get it to go away."

Giessman, a gymnast as a youngster, tennis player as a high school student and a bicyclist now, all but stopped working out. Her hips couldn''t handle it.

Once, doctors would have had few options to present to Giessman; her mother, who has a similar problem, was told decades ago that the treatment included a full-body cast. But advances in hip surgery and a greater understanding of how the hip joint works are helping patients such as Giessman, now 27, of Brentwood. She is pain-free and back on her bicycle after undergoing two hip surgeries in the past two years.

Hip surgery was once considered treatment for the elderly. But thanks to better imaging techniques with MRIs and CT scans and improved surgical techniques that can correct problems without replacing the hip, surgery has become a viable option for younger people.

"Most older people with hip arthritis have had underlying hip problems their whole life, and the result is degeneration of the hip over time," says Dr. John C. Clohisy, assistant professor of orthopedic surgery at Washington University School of Medicine and Barnes-Jewish Hospital, who specializes in treating younger patients. "Now we''re treating early hip disease, not late hip disease."

The hip is a ball and socket joint with a ring of cartilage around the joint, which Clohisy says is similar to the meniscus around the knee. A variety of problems can occur.

The cartilage can tear. The joint can have a loose body in it. The ball could be "not quite round enough" to fit the socket, which is called impingement. The hip socket could be shallow, so the ball isn''t seated in the socket, which is called dysplasia.

Some of those problems are present at birth; others develop gradually. In the past, treatment often consisted of waiting for the problem to get so severe that the entire hip needed to be replaced.

"The problem is," Clohisy says, "you''re taking people''s most active time, the most active part of their life, and they have to live with the hip problem."

But in the past decade, new procedures have come to the forefront:

• Hip arthroscopy: This procedure, which Clohisy says can be ideal for young, active people, is just like having your knee "scoped." It''s used when there''s a tear in the joint or a loose body. Lois Enders, 34, a professional dancer from Fenton, underwent arthroscopic surgery on her hip in August 2005, and within months she was performing yoga and stretches she hadn''t been able to do before the surgery.
• Osteotomy: A surgeon repositions the bones around the hip in this procedure, which is commonly used to treat dysplasia. Giessman underwent this surgery twice, once on each hip.
• Hip replacements for younger people. In the past, maybe 80 percent of hip replacements would last for 20 years, which Clohisy calls a "big ballpark figure." For younger patients, who were more active and therefore harder on the replacement joint, that figure could decrease by half. Now, with stronger materials such as titanium, surgeons are hoping that replacements for younger patients will last for 20 years.

Ellen Hager, 40, of Clayton, always knew she would need a hip replacement, but she figured that day would come about age 50. She was born with dislocated hips, but they were not discovered until she was 18 months old, when she wobbled as she started to walk. A body cast as a toddler and reconstructive hip surgery at age 13 helped, but as she grew older, the pain grew intense.

Hager discovered that she didn''t have to wait until she was 50, and she discovered that the recovery wasn''t horrible, either.

Clohisy replaced her left hip with a titanium stem and a titanium ball and socket four years ago. Four months after the surgery, she walked a mile and a half in an autism charity walk, an event for which she was the logistics chairwoman, as part of a team named Totally Hip Hagers. (They wore tie-dyed T-shirts, too.)

"I wish I would have done it sooner," says Hager, who hadn''t even entertained the possibility. "It''s just so life-changing. I basically have been in pain my whole life, and after this hip surgery, I have no pain at all."

Hager can walk up to three miles. She even completed the MS 150 bicycle ride, a two-day, 150-mile event. She had always pushed herself to try to be active, but now she is able to enjoy such activities without pain.

And that''s what Clohisy says makes his job so rewarding.

"It''s a fun population to help," he says. "A lot of them are at their wit''s end, and we tell them there''s a new treatment, and we''re able to help them out."