Hip Injuries in Athletes 2015
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This document discusses hip injuries in athletes. It notes that hip injuries are the second most common injury in college athletes. Many are soft tissue injuries that improve with rest and treatment, but some require surgery. It describes a former basketball player, Steve, who had chronic hip pain for many years before receiving a hip replacement. The document then discusses causes of hip pain like impingement from activities like running and squatting. It introduces the concept of femoroacetabular impingement as a cause of hip injuries and labral tears. The treatment of impingement through hip arthroscopy is discussed along with the story of another athlete, Jason, who was successfully treated this way.
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Hip Injuries in Athletes 2015
- 1. Hip Injuries in Athletes Andrew B. Wolff, MD Washington Orthopaedics and Sports Medicine www.andrewwolffmd.com www.wosm.com
- 2. Hip Injuries • In college athletes, 2nd most common area for injury Shankar et al. Am J Sports Med. 2007
- 3. Hip Injuries in Athletes • A large percentage of these injuries are soft tissue injuries that get better with time, therapy, NSAIDs, ice, etc.
- 4. • But some of them don’t… • Some “rub some dirt on it” and keep playing • Others can’t
- 5. Steve • 37 year old former Division 1 basketball player • Always had hip pain • Missed several games • Diagnoses included: Groin strain, abdominal wall strain, bursitis, tendinitis, etc.
- 6. What are the signs of a hip problem? • Recurrent injuries or chronic pain around the pelvis – Groin pain, Groin pain, Groin pain – Buttock pain – Trochanteric bursitis – Hamstring injuries – “Sports Hernias” • Abdominal wall injuries • Groin strains
- 7. Typical Causes of Hip Pain • Twisting/Torqueing/Squ atting –Cross-fit • Running • Prolonged sitting –Plane rides/ long car rides • Walking uphill • Getting in/out of car • Achy night pain?
- 8. “C” Sign
- 11. Steve and the Shrinking Envelope • Pain all the time • Pain with sitting • Can’t exercise • Pain at night— particularly after exertion • Aleve around the clock
- 12. Total Hip Arthroplasty • Among the most successful procedures done in medicine – Quality of life improvement – Success Rate
- 14. Hip Arthroplasty Downsides • Would prefer to be older • Implants can wear out • Subsequent surgeries harder • Limit activity level to prolong life of implant • Can’t “unreplace” your hip
- 15. Why Does the Hip Wear Out?
- 16. What About “Normal” Hips?
- 17. “It’s a Complicated Joint…”
- 20. Femoroacetabular Impingement •In 1990’s Ganz and colleagues introduced the concept of Femoroacetabular Impingement (FAI) as a cause of hip pain, labral tears, and early osteoarthritis (Ganz et al. Clin Orthop Rel Res 2003)
- 21. PincerCAM Espinosa et al J Bone Joint Surg 2006; 88-A: 225-239 Femoroacetabular Impingement
- 23. FAI:FAI: Pincer TypePincer Type
- 28. contre-coup
- 29. contre-coup
- 32. FAI:FAI: Cam TypeCam Type
- 48. Meanwhile…
- 49. First Hip Arthroscopy: Denmark, 1912
- 50. Progress 1912 Mid 2000’s NowSteve
- 51. Jason • 20 year Division 1 basketball player • Progressive hip pain for 2 years • Missed much of sophomore season • Diagnosis?
- 52. Jason & Steve
- 53. Progress 1912 Mid 2000’s NowSteve Jason
- 54. Jason
- 55. Jason
- 58. Post-op care • Crutch-aided walking for 2- 3 weeks • PT x approx 12 weeks • Return to full activities 3-6 months
- 59. Ongoing Research • MASH trial – Multi-Center Arthroscopic Surgery of the Hip • Washington, DC • Chicago • Philadelphia • Pittsburgh • Indianapolis • Winston-Salem • South Florida • Vail
- 60. Anesthesia for Hip Arthroscopy • Podium presentation at International Society for Hip Arthroscopy Meeting in Rio de Janeiro • Defines optimal nerve block anesthesia to: – Limit narcotic intake – Improve pain – Speed recovery – Enhance safety
- 61. Origins of Impingement • Podium Presentation at American Association of Hip and Knee Surgeons, Dallas, TX – Clear association between impingement and hormonal abnormalities in young women – Ongoing collaboration with NICHD to further study
- 62. HOP Test Multicenter Trial • Test to assess readiness to return to sport • Validated tests for knee, none for hip • Multicenter – Washington – Rochester – Pittsburgh – Chicago
- 63. Labral Reconstruction • One of the largest series of successful arthroscopic labral reconstructions in the world
Editor's Notes
- -sports medicine -focused on hips because it’s a fascinating joint that we can really help people with -very difficult to understand the hip and the injuries that go on around it, and also very difficult to treat well surgically
- By the time I met Theo, he had fairly advanced arthritis. When he played college basketball, we didn’t really have a grasp on his situation—or if we did, we didn’t have any good treatment options for him. Now we do. And I will get into what Theo’s problem was, but first I want to talk about the solution that he needs now—which isn’t all bad. And the history of our understanding of the hip joint.
- Fig. 1-A Line drawing illustrating the pathomechanism of “cam”-type impingement. It is caused by an abnormal shape of the anterior aspect of the femoral head and neck resulting in anterior impingement as the abnormally large prominence enters the acetabulum during motion, especially flexion and internal rotation. In this illustration, an abnormally shaped femoral head and neck articulate with a normal acetabulum. The dashed line represents the normal femoral head-neck contour. The small black arrows indicate the abnormal anterior bone that decreases the normal headneck ratio and causes impingement in flexion, internal rotation, and adduction, leading to damage of the acetabular labrum (white arrow). The large curved black arrow indicates internal rotation of the hip. Fig. 1-B Line drawing illustrating the pathomechanism of “pincer”-type impingement, which is the result of contact between the acetabular rim and the femoral head-neck junction. There may be a normal head-neck ratio, but the neck may reveal an indentation (a “kissing” lesion [white arrow]) caused by acetabular prominence (small black arrows). The femoral head-neck junction abuts and levers against the border of the acetabular rim, which serves as a fulcrum. In addition, high shearing forces between the posterior aspect of the femoral head and the acetabulum (a “contrecoup” lesion [large, broad black arrow]) are produced in internal rotation. Although rare, the same lesions can occur in a reverse manner if external rotation is performed. Posterior lesions may be seen in the presence of acetabular retroversion or acetabular protrusion. The large curved black arrow indicates internal rotation of the hip.
- How many of you are athletes with hip problems? How many of you don’t qualify as athletes, but have hip problems? Talk about background -sports injuries -sports medicine -focused on hips because it’s a fascinating joint that we can really help people with -very difficult to understand the hip and the injuries that go on around it, and also very difficult to treat well surgically