By Bryan Hanypsiak, M.D., Board Certified Orthopedic Surgeon
People that are experiencing pain in their hip or groin area may be suffering from hip arthritis or a pre-arthritic condition called Femoral Acetabular Impingement (FAI). The pain may occur after standing from a seated position or when sitting for prolonged periods of time. It may be activity related, associated with particular leg positions, or may be most intense at night when other distractions are at a minimum.
Femoral Acetabular Impingement is the number one reason patients need a hip replacement before the age of 60. It describes a collection of conditions in which the thigh bone, or femur, makes irregular contact with the socket, or acetabulum. It can be caused by an irregularly shaped femur or socket. This contact, or impingement, causes damage to the acetabular labrum, a highly innervated, cartilaginous structure that makes the acetabulum deeper and helps hold fluid inside the hip joint. This fluid acts as a frictionless bearing, allowing a thin layer of fluid to remain between the femoral head and acetabulum when you walk. The fluid is pressurized when you step down on the leg, and drive the ball into the socket. This fluid layer forms a barrier that minimizes contact pressures between the ball and socket. A disruption, or tear, in the labrum allows this fluid to escape from the hip joint during walking, and leads to increased contact pressures in the joint and damage to the cartilage. Loss of, or damage to, the articular cartilage that covers the ends of bones inside your hip joint is known as arthritis.
Most patients with hip pain will require x-rays and a special kind of MRI called an MRI arthrogram in which a radiologist injects dye into the hip to help identify labral tears. If dye is seen between the labrum and the underlying bone, it indicates a tear.
If identified early, FAI can be treated with physical therapy, injections, activity modification and anti-
inflammatory medication. For patients who do not improve after three months of non-operative treatment, FAI can be treated surgically with hip arthroscopy, a procedure during which a surgeon places a small camera inside the hip joint. Once inside, the labrum can be repaired or replaced, and the bones reshaped to a more natural contour.
Hip arthroscopy is performed as an outpatient surgery, and patients go home the same day. Most patients will need crutches for 2 weeks, and a brace to help maintain their hip in ideal position. Physical therapy is started immediately post-op and most patients are back to all sports in six months.
Hip arthroscopy is not for everyone. Research has shown that hip arthroscopy is not beneficial in patients with advanced arthritis, and patients with moderate arthritis may see an increase in their symptoms. For patients who are not candidates for arthroscopy, ultrasound guided injections performed in the office can help alleviate pain and motion loss. Platelet Rich Plasma (PRP), aspirates containing stem cells, and cortisone can be safely injected into the hip using ultrasound to identify the hip joint.
For patients who are not candidates for hip arthroscopy and do not respond to non-operative treatments, hip replacement remains the best option to relieve pain and restore function to the hip joint.
As a surgeon, you make a life long commitment to learning. Surgical techniques and instrumentation evolve rapidly, and you must constantly keep up with that evolution in order to ensure your patients the improved outcomes they deserve. Since I completed my training, I’ve gone to hundreds of meetings and training courses to learn the latest techniques so that I may offer them to my patients. I don’t perform a single surgery the same way now as I did when I trained 15 years ago. The field of hip preservation has evolved at an incredible pace, and we are committed to keeping pace so that you can find all of the latest state of the art treatments and procedures at Physician’s Regional Hospital.
Same-day consultations are often available. Request an appointment online at PhysiciansRegionalMedicalGroup.com or call 239-348-4221