Dancer kicking up her heels after hip surgery

October 23, 2020
Dr. Van Nortwick poses while dancer Lily Pace kicks her leg over her head in the play area on the roof of the children's hospital
Two years after Dr. Sara Van Nortwick operated on her hip, Lily Pace is dancing up a storm. Photos by Sarah Pack

It’s hard for Lily Pace to express in words how much dance means to her. But two years ago, as she and her mom drove away from yet another doctor, while searching for an answer to Lily’s searing hip pain, Marijon Clarke glanced in the rearview mirror and saw tears streaming down her daughter’s face. Lily didn’t know if she would be able to keep dancing.

“Every doctor said something different,” she recalled recently.

A fluke of insurance coverage brought them to MUSC Children’s Health and Sara Van Nortwick, M.D., a pediatric orthopedic surgeon. That turned out to be a blessing in disguise, Clarke said.

“Dr. Van Nortwick seemed very positive. She said, ‘I'm going to give you the best outcome that’s possible.’ And she did. Lily’s back,” Clarke said.

Now, almost two years after a periacetabular osteotomy surgery, or PAO, Lily is rehearsing for the role of Sugar Plum Fairy in “The Nutcracker.”

“Saving the hip is far more satisfying than replacing the hip. My PAO patients are some of my happiest patients, as they generally come to me with significant pain and truly feel the operation is life changing."

Sara Van Nortwick, M.D.

Van Nortwick said the PAO surgery corrects the hip dysplasia that causes pain for patients like Lily by restoring normal anatomy. Not only does this alleviate existing pain, but it prevents the hip joint from developing arthritis.

“Unfortunately, hip dysplasia in teens and young adults too often goes undiagnosed, and patients aren’t referred to a surgeon specialized in hip preservation. Hip dysplasia can’t be cured or treated if it’s not recognized. The findings can be subtle to someone who doesn’t look at hips all day,” Van Nortwick said.

“Physical therapy, injections and hip arthroscopy can’t cure hip dysplasia, so patients often deal with symptoms for years before finding a hip preservation specialist,” she added.

Those treatments don’t work because the problem lies in the anatomy. The top of the thigh bone, or femoral head, is supposed to fit neatly into the acetabulum of the pelvis, forming a ball-and-socket joint. When someone has hip dysplasia, the socket doesn’t adequately cover the ball. Activity causes the femoral head to load the socket inappropriately, producing pain, tears in the cartilage called the labrum, and early arthritis.

Pediatricians look for hip dysplasia in newborns. But more subtle hip dysplasia can occur later in development and cause problems in teenagers and young adults.

That was the case for Lily, who was 13 when she had the surgery. She had been dealing with pain for some time but had initially downplayed it to her mother, for fear she would make her stop dancing.

“Finally, at a competition, her friends were like, ‘She’s not telling you, but she’s in a lot of pain,’” Clarke said.

Dr. Van Nortwick poses with patient Lily Pace in the play area on the roof of the children's hosptial 
Dr. Van Nortwick and Lily Pace in the outdoor play area of the MUSC Shawn Jenkins Children's Hospital.

They tried physical therapy, a chiropractor and a variety of doctors before meeting with Van Nortwick. Although the labral tear could be tended to with a minimally invasive surgery, Van Nortwick explained that it would be inappropriate to fix the labral tear without addressing the underlying anatomical problem. 

“A lot of people think, ‘That sounds like a big procedure. I’d rather just have a hip scope,’” Van Nortwick said. And the PAO is a big procedure. The surgeon cuts through the pelvis to reposition the acetabulum correctly. It’s held in place with screws, but the bone quickly heals. With the corrected anatomy, patients regain full range of motion and can return to the sports and activities they love without pain.

“Many hip replacements done in adults less than 50 years old are the result of undiagnosed hip dysplasia. The PAO was first done in Switzerland about 20 years ago and is relatively new,” said Van Nortwick, who has special training in hip preservation, including completing a fellowship in pediatric orthopedic surgery.

“I love this operation, as it gives patients their lives back,” Van Nortwick said. “Lily is obviously a very talented young lady, and I’m thrilled she has been able to return to her high level of function pain-free. The results of PAO surgery are very durable in young people like Lily; catching her hip dysplasia early has prevented her from developing arthritis and the need for a hip replacement at an early age.

“Saving the hip is far more satisfying than replacing the hip. My PAO patients are some of my happiest patients, as they generally come to me with significant pain and truly feel the operation is life changing.”

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