Undiagnosed hip disorder leads to years of pain Stony Brook brother and sister have surgery on same day in NYC
By Robin Frank
July 02, 2008 | 02:48 PM A Stony Brook brother and sister are giving new meaning to the phrase "all in the family." Justine and Michael Miano share more than a great sense of humor and outgoing personalities. Both had operations on March 13 at the Hospital for Special Surgery in Manhattan to repair similar hip problems that caused pain, limited their activities — and had gone undiagnosed for years. Justine Miano, 16, and her brother Michael, 21, suffered from hip pain for as long as they could remember. As young children their pediatrician dismissed it as "growing pains." But as they got older, the pain didn't go away, and certain activities made it worse. "Some doctors diagnosed their problem as a muscle strain," said their mother, Regina Miano. "They told me to leave it alone." Finally, at the end of 2006, orthopedic surgeon Dr. Brian McGinley in Port Jefferson examined the siblings, determined the problem was more severe, and referred the Mianos to HSS in New York City. Regina and Henry Miano, a retired FDNY fireman, with Justine and Michael, consulted with Dr. Robert Buly, an orthopedic surgeon specializing in conditions affecting the hip at HSS. "It is not uncommon for doctors to misdiagnose such problems in children as 'growing pains,'" said Dr. Buly. "It's important that any young person with persistent hip pain be properly diagnosed and treated. Left untreated, certain conditions can lead to early arthritis and necessitate a total hip replacement." According to Henry Miano, that is exactly what would have happened "at the age of about 30." Dr. Buly diagnosed the condition as hip impingement, a mechanical disorder that tends to run in families. The Mianos were relieved to finally have a diagnosis, but surgery would be needed. "Ever since I was young I had hip pain," Justine Miano said. "Sometimes it was excruciating, and I had trouble walking." Her brother, active in sports, had similar distress. "I had the pain for as long as I can remember," he said. "But I got so used to it that I stopped complaining." In his second year at the Savannah College of Art and Design, the pain was even worse, especially after playing lacrosse or other sports. He described it as "this extreme soreness" and "an immense dull pain in my core." "The goal of the operations was to relieve their pain and allow them to gain normal functioning of their hip joint," Dr. Buly said. The hip is a ball-and-socket joint, said Dr. Buly. In a healthy hip joint, the ball rotates freely in the cup, allowing for smooth movement and stability. Cartilage, a protective tissue, lines the bones and limits friction between the surfaces during movement. Impingement results when the joint is not operating properly. Due to an anatomical abnormality, normal hip motion is blocked or restricted, causing damage, and can lead to hip arthritis at a young age. In the case of the Mianos, the condition caused pain, instability and torn cartilage in their hips. Justine and Michael Miano were in private rooms next to each other at HSS for their operations. Dr. Buly was able to perform minimally invasive surgery, making small incisions. The Mianos spent four days in the hospital, followed by physical therapy. The surgery was performed during spring break, so Michael only missed three days of classes. Justine was at home for eight weeks, but Ward Melville High School provided a tutor almost every day. "Three Village was great," Regina Miano said. Justine returned to classes in May and begins her senior year at Ward Melville in September. Back at Savannah Michael Miano was soon able to resume bike riding, swimming and walking for exercise. He continues to improve and looks forward to getting back to other sports. Justine, who had a more extensive operation, is also making good progress and has an excellent prognosis, according to Dr. Buly. Michael Miano, who is doing an internship this summer at Forbes Magazine, will probably have surgery on the other hip in December. Dr. Buly recommended Justine wait a year to fully recover before surgery on her other hip. For now, the Mianos, who also have an unaffected son, Christopher, 19, who attends Suffolk County Community College, are relieved Justine and Michael will soon be able to enjoy life pain-free. "I only wish more doctors recognized these hip problems in young people and didn't dismiss them as growing pains," Regina Miano said. For more information visit hss.edu/longisland or call 866-606-6888. Lee Lutz contributed to this story.