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Hip mobility and hip arthroscopy

By David Pearce, M.D.

If you have pain in your hip, you may have a condition called femoroacetabular impingement (FAI). In simpler words, this means the ball of your thigh bone or femur does not have a full range of movement in your hip joint.

Most often, FAI is caused by excess bone that has formed around the head of the femur. 

Physicians at West Tennessee Bone & Joint Clinic will first look at non-surgical treatment to reduce the pain and swelling in your joint. FAI often can be resolved with rest, modifying one’s behavior and a physical therapy and/or anti-inflammatory regimen.

When that does not work, however, surgery may be necessary. Traditionally, surgeons have corrected the problem through an open incision near the joint.

However, Dr. Adam Smith and I have received special training in a better surgical approach to this problem — hip arthroscopy, which is less invasive and easier on the patient. While open surgery requires a longer hospital stay, arthroscopic surgery is an outpatient procedure. The patient goes home the same day.

We now regularly treat FAI with arthroscopic surgery and have good results. In fact, after hip arthroscopy, many patients return to the level of physical activity they had before the problem occurred.

FAI is often the result of normal bone growth and development. The extra bone can appear on x-rays as a small “bump.” However, when the bump repeatedly rubs against the cartilage, the cartilage can fray or tear, resulting in pain. As more cartilage is lost, arthritis can develop.

Tears of the labrum (cartilage on the outside rim of your hip joint socket) also can fold into the joint space, further restricting motion of the hip and causing more pain. This is similar to what occurs in the knee of someone with a torn meniscus.

Other causes of the problem include falling on one’s hip and athletic activities that involve repetitive pivoting movements or repetitive hip flexion.

Impingement can present at any time between the teenage years and middle age. Many people first realize a pain in the front of their hip (groin) after prolonged sitting or walking. Walking uphill also may be difficult. The pain can be a consistent dull ache or a catching and/or sharp, popping sensation.

With hip arthroscopy, we make two to three small incisions — about one-fourth to one-half inches long. We insert the surgical instruments into the joint through these incisions.

Our instruments include an arthroscope, which is a long thin camera that allows us to view the inside of the joint, and a variety of “shavers” that allow us to cut away the excess bone or tissue. Specialized implants allow us to repair torn labral tissue, as well. Flushing saline through the joint helps to give us a good view of the surgery.

After the procedure, patients normally are given crutches to use for the first two to four weeks to minimize weight-bearing. The patient normally begins a physical therapy regimen to improve strength and flexibility in the hip.

After six weeks of physical therapy, many patients begin to resume more normal activities, but it may take three to six months before they experience no soreness or pain after strenuous physical activity.

We determine whether patients are suitable for hip arthroscopy on a case-by-case basis. Those who respond best to hip arthro- scopy are active individuals with hip pain, where an opportunity exists to preserve the cartilage they still have. Patients who have already suffered significant cartilage loss in the joint may be better suited for a more extensive operation, such as hip replacement.

Studies have shown that 85 to 90 percent of hip arthroscopy patients return to sports and other physical activities at the level they were at before their onset of hip pain and impingement. The majority of patients clearly get better, but it is not yet clear to what extent the procedure stops the course of arthritis.

Advances have made hip arthroscopy a safe and effective alternative to open surgery of the hip, a tremendous advantage in treating early hip conditions that ultimately can advance to end-stage arthritis.