The Hip Duo: Elevating Orthopedic Care in the Black Hills

By Alex Strauss

Dr. Milligan & Dr. Krohn of Monument Health Orthopedic and Specialty Hospital

Hips are tricky. Even a perfectly formed hip is likely to start showing signs of wear and tear - and may even need to be replaced - by the time its owner is in their 50s or 60s. For children born with hip dysplasia, or those whose hips are damaged by trauma or disease, that timeline can be even shorter. What is worse, these patients may spend decades in life-limiting pain without a definitive diagnosis.

"They may be told that the pain in their hips is a groin sprain and to treat it with NSAIDS or they may be told they have an abnormality but there is nothing they can do about it," says orthopedic surgeon Kenneth Milligan, MD, of Monument Health Orthopedic & Specialty Hospital. "In the past, they would have no other option but to live with the pain until they get a hip replacement. If you are 12 or 14, that is a tough thing."

Fortunately for children and adolescents with hip pain in the Black Hills region, Dr. Milligan and his colleague, pediatric orthopedic surgeon Eric Krohn, DO, understand the hips of children and adolescents like few others do.

Rare Skills Benefit Young Patients

Dr. Milligan is a hip specialist who trained and conducted research alongside some of the top names in hip surgery at the University of Colorado. He assisted on UC's very first periacetabular osteotomy (PAO) procedure, a complex surgery to reposition the hip socket for improved function and stability in people with hip dysplasia.

With Dr. Milligan's arrival at Monument Health this past fall, Black Hills hip patients can now access this advanced treatment rarely available outside of a university setting.

As a pediatric orthopedic surgeon at Monument since 2022, it is Dr. Krohn's job to find and fix problems in the hips and other joints before they are serious enough to need Dr. Milligan's expertise. Hip dysplasia is one of the most common childhood conditions he treats, occurring in about 1 in 1,000 newborns.

Dr. Krohn is from Washington state and did his pediatric orthopedic training at the University of Michigan. Hip dysplasia is one of the most common childhood conditions he treats, occurring in about 1 in 1,000 newborns.

"Our goal is to find these as early as possible when there are more treatment options," says Dr. Krohn. "For instance, I can do a Salter osteotomy which realigns the acetabulum so that it better covers the femoral head. I can also do femoral osteotomy which addresses deformities in the femur.

"In the adult world, you're often looking at trying to make a bad situation a little less bad, but in my population, you can hopefully make it so their situation is much, much better than it would have been otherwise."

Early Intervention for Better Outcomes

But if a child with dysplasia is asymptomatic or is incorrectly diagnosed, their real problem may not be found until their bones are more solid. That's where the PAO procedure shines.

"A PAO is a very complex procedure," says Dr. Krohn. "While I do a lot of work around the pelvis, a PAO is not something I would do by myself without someone with the kind of training Dr Milligan has. We needed his technical skills to be able to offer this."

In his training, Dr. Milligan saw career athletes return to professional level sports after a PAO. Now, his first local patients are seeing similar successes.

"We did a PAO back in November on a teenager that had been having pain in the hip for four years and had pretty much stopped participating in all sports," says Dr. Milligan. Several rounds of therapy did not help and careful measurements showed significant dysplasia. Three months after a PAO procedure, the patient has returned to a normal gait and has even been out hiking.

Comprehensive Hip Care for All Ages

Although dysplasia is one of the most common hip problems Drs. Krohn and Milligan treat, they are quick to emphasize that there are many potential causes for hip pain.

"An example might be a child with slipped capital femoral epiphysis (SCFE) where part of the femoral head sloughs off and they can end up with severe deformities of the ball side of the hips," says Dr. Milligan. "There can be people with avascular necrosis in the hips. Steroids, infection, trauma, and surgery in the hip can all do this, so PAO is not the only thing we do for hip pain."

Both say the key to effective long-term relief is to work with providers who deeply understand the complexity of the hip joint.

"You don't need a bigger hospital to do some of these procedures, you just need people with the right expertise," says Dr. Krohn. "We want to see anyone, at any age, with hip pain. If we can't figure it out, I'm betting no one else can."