One of the most exciting and potentially beneficial recent advances in orthopedic surgery has been the use of arthroscopy to repair injuries of the hip joint. View this presentation to learn more about this advance in hip treatment.
Erica Brinker VP of Strategy and Marketing Recent Advances in Arthroscopic Hip Treatment
Recent Advances in Orthopedic Surgery One of the most exciting and potentially beneficial recent advances in orthopedic surgery has been the use of arthroscopy to repair injuries of the hip joint. These techniques have gained significant exposure as prominent athletes such as Alex Rodriguez, Kurt Warner and Greg Norman have undergone hip treatment procedures. Many recreational athletes and non-athletes have also experienced relief from their hip pain with arthroscopic hip treatment procedures. In addition, it is thought that the hip treatment procedures may delay or prevent the need for hip replacement.
What is the “Hip” Joint When orthopedic surgeons refer to the “hip” joint, they are directly referring to the ball-and-socket joint formed by the top of the thigh bone (or femur) and the hip socket (or acetabulum.) The top of the femur is a large ball covered by smooth articular cartilage. This “femoral head” is connected at an angle to the main shaft of the femur by the “neck” of the femur. The acetabulum is a deep socket formed by the coalescence of the bones of the pelvis. Most of the socket is covered by articular cartilage. The labrum is a rim of rubber-like tissue that is attached circumferentially along much of the rim of the socket.
What is the “Hip” Joint It acts like a washer or gasket, providing stability to the hip joint and distributing stress. Its function is similar to the meniscus in the knee and the labrum in the shoulder. Other important hip-joint structures include the ligamentum teres that connects the femoral head to the acetabulum, the hip-joint capsule that surrounds the entire joint and some of the most powerful muscles in the body.
Acute Injuries and Hip Treatment The normally functioning hip joint is very stable by virtue of its deep socket, and it absorbs high forces as we walk, run and exercise. Because of the powerful muscles that move the hip, simply standing on one leg can cause the hip to experience forces three times the weight of your body. Activities such as running, weightlifting, dancing, swinging a club or kicking a ball place even greater stress on the hip. And, over time, these stresses can cause the normal structures of the hip to be injured and require hip treatment. Acute injuries including tears of the labrum, injury to the articular cartilage, tendinitis, stretching of the capsule and tendon or ligament tears can also require hip treatment.
Impingement and Hip Treatment The shape of the femur and acetabulum are also implicated in causing injury to the hip through a mechanism termed “impingement.” his “femoro-acetabular impingement” (or FAI) is abnormal contact between the rim of the socket and the neck of the femur and commonly requires hip treatment. Repeated contact in these areas can be painful as the labrum gets pinched, and tears in the labrum and articular cartilage can develop. A femoral head and neck that is more cam-shaped, rather than round, can also predispose to impingement. Occasionally, a hip treatment patient will have a combination of both types of impingement.
Impingement and Hip Treatment The location of the hip treatment patient’s pain from FAI and labrum tears is usually in the groin and/or the side of the hip. The symptoms usually worsen with activity and are alleviated by rest. A catching or popping sensation in the hip is often reported by patients who require hip treatment, especially when arising from a seated position, getting into or out of a car or other activities that flex and rotate the hip.
Diagnosis and Hip Treatment An orthopedic surgeon who is an expert in the diagnosis and treatment of hip problems is the best person to evaluate for femoro-acetabular impingement and labrum tears. This evaluation will include a comprehensive history and a physical examination, as well as x-rays of the hip. X-rays can help determine if the hip has too much arthritis, indicating that a patient would be better suited for hip replacement. MRI scans are very sensitive at detecting injuries such as labrum tears, although, occasionally, an MRI scan will overlook these injuries. CT scans and hip injections can also be used to aid in diagnosis and surgical planning.
Advances in Arthroscopic Surgery Within the last several years, the ability to treat these hip conditions arthroscopically has been developed. Arthroscopic surgery is a minimally invasive technique. This means that labrum tears, articular cartilage injuries, hip instability and bone malformations in many cases can be corrected through two or three small incisions using a small camera called the arthroscope. This is similar to arthroscopic surgeries on other joints such as shoulder labrum repairs and knee meniscus trimming.
Advances in Arthroscopic Surgery As this procedure has gained popularity among orthopedic surgeons, specific surgical techniques and instruments have been developed to address the unique challenges of hip arthroscopy. For example, hip labrum tears can be repaired using small anchors inserted in the bone around the rim of the acetabulum. The surgeon passes the suture attached to these anchors around the labrum. The anchors act like tent stakes, holding the labrum in place against the bone until the body can heal it in place.
Advances in Arthroscopic Surgery An essential part of any hip arthroscopic surgery is addressing bone abnormalities such as the cam-shaped femoral neck and the excessively deep socket. These conditions are often present in addition to labrum tears and indeed contribute to the labrum tears developing. During the arthroscopic surgery, these bones can be reshaped to alleviate the femoroacetabular impingement. Clinical studies have shown that these surgical techniques provide excellent pain relief in most patients. The benefits of doing the surgery arthroscopically include smaller incisions, quicker recovery, less pain and no overnight hospital stay.
About the Author Erica Brinker is Vice President of Strategy and Marketing at the CORE Institute, which began practicing in 2005 to fulfill a vision of orthopedic excellence encompassing the entire spectrum of orthopedic sciences. Learn more about hip treatment and other orthopedic topics by visiting http://www.thecoreinstitute.com/.