Artificial hip implantation in a child is one of the most selective and complicated surgical decisions in orthopedics, especially when it comes to a patient in active growth. That is why the case of 14-year-old Mihajlo represents a pioneering step in Macedonian medicine – for the first time in the country, a hip replacement has been performed in a child of this age, an intervention that used to be considered as extreme one and extremely rare option. The intervention was performed by the surgical team of Acibadem Sistina Hospital: Prof. Viktor Kamnar, MD, PhD, an orthopedist, and Prof. Igor Kaftandziev, MD, PhD and Mihajlo Ivanovski, MD, traumatologists.
Mihajlo suffers from avascular necrosis of the head of the hip (Legg Calve Perthes Disease), a diagnosis that occurs in childhood but resulting over time with complete joint destruction. His condition progressed to a significant shortening of the leg by over 4.5 centimeters, walking on toes, pelvic curvature and secondary spine deformities, seriously damaged body biomechanics and severe pain. The prognosis, if no intervention was made, would be severe disability.
“It is an extremely selective surgical procedure. When it comes to children, there is great controversy whether to wait for growth to finish or to intervene earlier. However, there are clear indication areas, such as in this case, when practically there is no other treatmentoption”, explains Prof. Dr. Viktor Kamnar, the orthopedist who performed the intervention.
Technically, the surgery is significantly more complex than in adult patients. The child’s hip contains a large percentage of cartilage tissue, and any mistake can lead to an unstable implant and serious consequences in the future. An additional challenge is the precise extremity lengthening – enough to correct the asymmetry, but also to predict further growth.
"The purpose was to simultaneously obtain a stable hip, equalize the extremity, completely eliminate the pain and overcome disability to the maximum extent possible. There is no 100 percent certainty in surgery, therefore the burden and responsibility of this intervention are extremely high", adds Prof. Kamnar.
The decision to undergo surgery followed a long and thorough preoperative preparation, leaving no room for a risk. The very next day following the surgery, physical therapy began, and the child straightened up in a short time, stopped walking on his toes and today he walks almost without an aid. The present muscle hypotrophy, as a result of the long-term disuse of the leg, is gradually being overcome with rehabilitation.
For the family, this intervention meant the end tothe more than a year and a half uncertainty
“After more than a year and a half looking for the best orthopedists in Austria, Bulgaria and Macedonia, we finally found the right doctor for Mihajlo. Although many offered surgeries not relevant for his diagnosis – Perthes – no one wanted to perform the necessary hip replacement in a child of only 14 years. Behind his courage that we noted every day, there was a heavy psychological burden. It all started with a simple fall in a physical education class, playing football in March 2024, followed by months of uncertainty, pain and online classes that further affected him.
The turning point happened on November 7, 2025, when Prof. Viktor Kamnar, MD, PhD performed the surgery that changed his life. I will never forget the moment when after three hours he came out of the operating room and said to me: “Dragica, everything is fine. Excuse me… I’m going to sit down, it was stressful for me too – still he is a child at the age of my son. I performed the surgery under special emotions". Those words will forever remain in my heart.
Just three days later, on November 10, 2025, Mihajlo climbed the 15 stairs to the apartment by himself. His smile returned, his confidence returned, and we finally felt a relief. We express our deepest gratitude to Prof. Dr. Kamnar for his extraordinary expertise, humanity, and courage to undertake the surgery that no one else had performed", said Mihajlo's mother and father.
This case is not only a medical success, but also a strong message about the courage of modern medicine to make difficult, but important life decisions - especially when it comes to a childhood that deserves a future without pain.
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