Whether you’re an athlete or simply live an active lifestyle, hip pain can become a major hindrance to daily life. But how do you know whether or not surgery is the right choice? If you can no longer participate in the activities you once could due to your hip pain, it might be time to consider an initial visit to an orthopedic specialist at the Kansas City Orthopedic Alliance, to discuss your symptoms. Hip arthroscopy may be a viable option.
Several of our physicians (Dr. McCabe, Dr. Carlisle, Dr. Doan, Dr. Wait) specialize in sports medicine and hip pain in patients of all ages, with a focus on hip pain in patients who don’t require a hip replacement. These physicians focus on restoring function, decreasing symptoms and educating patients about how to avoid future disruption.
If you think you or someone you know may need a hip scope (also known as hip arthroscopy), you should always speak to your physician before making a decision. To help you on your journey, you can read on for more detailed information about the procedure.
The anatomy of the hip
Before we can discuss how a hip arthroscopy works, there are some basic things you should know about the hip joint in general.
There are different types of joints in the body; the hip is a “ball-in-socket” joint. Just as the name suggests, a ball-in-socket joint consists of a ball-like structure that moves inside a depression in the bone to allow for rotational movements. In the hip, the joint is created by the ball-shaped head of your thigh bone (femur) that fits into the hip socket (acetabular socket).
Around the “rim” of the hip socket is a ring-shaped ligament called the labrum. The labrum has three main functions:
1. Seals the femoral head or “ball” to keep fluids within the joint
2. Helps stabilize the hip joint
3. Protects the surrounding the cartilage
Hip impingement causes the labrum to tear, which often leads to a decrease in your range of motion along with pain (which can range in severity). In regards to sports medicine, hip impingement is the most common reason someone may need a hip arthroscopy.
What is hip impingement (FAI)?
Hip impingement is the unnatural movement of the femoral head inside the acetabular socket. Most people have a nice slope between the head and neck (narrow portion of the femur), allowing the ball of the femur to fit securely into the socket.
However, not everybody and their bones develop in an ideal way. There are instances where extra bony growths can form, which can affect how the femur articulates (connects) and moves within the hip socket. These bony growths can appear as bumps, and there are two main places this extra bone can appear.
1. Cam impingement: Excess bone growth appears around the head or neck of your femur. This is the most common type of hip impingement.
2. Pincer impingement: Excess bone growth appears on the hip socket or the socket sits at an abnormal angle.
Therefore the goal of hip arthroscopy is to shave away excess bone, repair any labral tears, and to improve how your hip joint moves.
Determining whether you have a hip impingement or labral tear requires a visit to a physician, along with an X-ray and/or MRI examination. Symptoms of a hip impingement include:
- Pain in your groin while sitting or walking
- Hip pain or tightness with physical activity/sports
- Pain along the side of your thigh and/or buttocks
Pain due to hip impingement can begin anytime between the teenage years to middle age and beyond. This occurs often in teenagers because adolescent growth may cause impingement bumps on the femur or the hip socket. Children who haven’t reached this stage do not typically see issues with hip impingement because their bones are still developing.
Considerations before having a hip arthroscopy
Hip arthroscopy surgery is typically a last means of correcting pain or dysfunction that a patient may be experiencing. If our specialists can create a positive outcome without providing surgical intervention, that is always our first choice.
Here are a few conservative treatment options we recommend at KCOA Orthopedics & Sports Medicine as an alternative to hip arthroscopy.
Exercise/Physical Therapy
Guided exercise (stretching, strengthening and functional movement) by a licensed physical or occupational therapist is a viable avenue for improving many different types of hip issues. While rest can be help, if there is significant inflammation in the joint, movement of the joint tends to be more helpful. Joints depend on natural lubrication from synovial fluid; similar to how oil lubricates gears, synovial fluid helps your joints move.
First, movement increases the amount of synovial fluid, which can help reduce pain. Second, motion increases circulation through the entire body. That circulation helps supply the necessary nutrients and oxygen needed to promote joint health.
You don’t have to engage in aggressive physical activity to get moving. The experts at KCOA often recommend consulting with a licensed physical or occupational therapist so patients can get the guidance they need to feel better.
Medications
At times, the pain becomes too much and hinders movement. In those instances, your doctor may recommend over-the-counter NSAIDs (anti-inflammatory medication such as Advil) or prescription medications. Especially with NSAIDs, you should always talk to your doctor to ensure they are the right treatment for you. Side effects can include stomach irritation, ulcers, or even kidney damage. Reasonable dosing and monitoring can help alleviate those side effects.
Injections
Another pain management option for hip pain and impingement is injections. Cortisone injections, for example, can help with inflammation, and the effects tend to last for 3 to 6 months before you might need another one. Many people manage their pain with injections and exercise.
Regenerative medicine
Regenerative medicine options, such as stem cell injections or platelet-rich plasma, can help nourish worn or damaged tissue. This option works best if you have mild-to-moderate hip pain, minimal tissue disruption and are a younger patient.
The history of hip arthroscopy
In the 1930s, Dr. Michael Burman pioneered the arthroscopy movement through a preliminary study of over 90 cadaveric joints. While the technique was in its infancy, it established the importance and impact arthroscopy could have on modern medicine.
Out of the 90 joints he studied, 20 were hip joints. During his examination, Burman found that hip imaging was limited to the femoral head and neck. That means he wasn’t able to see the hip cartilage or ligaments. From this initial study, he didn’t believe it was possible to fit a needle between the femur and the hip socket. It was easier to perform arthroscopy in the knees and shoulders, so hip arthroscopy was pushed to the background.
As knee and shoulder arthroscopies became more popular in the 1970s and 80s, it wasn’t until physicians saw a correlation between hip pain and labral tears that hip arthroscopies became more important. Dr. James Glick was a key figure in developing modern techniques for successful hip arthroscopies. He was also the one who found that traction enabled physicians to better see between the hip socket and femur. Traction is a method of slightly pulling down the femur to provide a viewable space between the ball and socket. This space is crucial for the camera to be able to take images of the joint and any abnormalities.
During this time, physicians mainly used hip arthroscopy procedures as a diagnostic tool to see problems that didn’t show up on X-rays. However, as time passed, physicians gained a better understanding of hip pathologies, allowing them to expand how they could use the procedure.
Over the decades, physicians have modified techniques and updated technologies to increase the efficacy of the procedure. Today, physicians like the experts at KCOA, can use hip arthroscopies to debride and repair labral tears, smooth abnormal bone growths.
How to prepare for hip arthroscopy
Your physician will give you more personalized information about how to prepare for your hip arthroscopy based on your needs. In general, you should set up arrangements for someone to drive you back home after the procedure and assist you with any mobility needs. If you have to stay at a hospital overnight, make sure you pack a bag with all of your essentials.
In addition, you will want to have a physical therapist picked out and schedule your post-op therapy sessions so you’re prepared for later down the road. If you aren’t sure of which physical therapist will work best for you, your physician can refer you to one that fits your needs and budget.
Physicians typically expect you to schedule your first physical therapy appointment two days after surgery (e.g. Thursday therapy for a Tuesday surgery).
Talk to your doctor about any blood thinners you may be taking (such as aspirin). In some cases, you might have to stop taking them for a certain period before your surgery.
What happens during a hip arthroscopy at Kansas City Orthopedic Alliance
Hip arthroscopies require general anesthesia; however, for most patients it is an outpatient surgery (you are not required to stay overnight). Make sure you have someone to drive you home and help take care of you after the procedure!
Once you are asleep, gentle traction may be applied to your leg in order to create space between the ball and socket to allow the camera to be placed into your hip.
From there, the physician will typically create two or three small incisions about ½” long. One incision is dedicated for the camera (arthroscope), and the other is used to place the various instruments to repair the labrum and joint. The arthroscope allows the physician to view the joint and pinpoint the problem. A saline-based fluid flows through the arthroscope to keep the image clear and bleeding minimal.
After accessing the hip problem and the condition of the labrum, they will begin the repair. Depending on your hip, this could include:
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- Reshaping the acetabular socket
- Reshaping the femoral head and/or neck
- Repairing the labrum with stitches
- Smoothing out the surrounding cartilage
- Removing inflamed tissue
Once the procedure is complete, they will close your incisions and apply an absorbent dressing. Although the process can vary from patient to patient, on average it takes about two hours from start to finish, including going to sleep and waking up.
What to expect: hip arthroscopy recovery
We understand that surgery may be a scary choice, and although hip arthroscopies aren’t as common as other arthroscopic procedures, the risks associated with this surgery are minimal. Those who don’t do well (or are at a higher risk) tend to have underlying conditions such as weight issues, heart disease, and diabetes. In those cases, it’s best to try to get as healthy as possible before you proceed with any type of surgery, including orthopedic surgery in order to minimize the risk of a complication.
You can expect to use crutches to get around for the first couple of weeks after a hip arthroscopy. Your physical therapy will usually start very soon after surgery. Physical therapy is crucial for walking normally, building strength, and getting motion back. Eventually your physical therapist will help you return to athletic activity, usually around 3 to 6 months after surgery.
How do I know if I’m a candidate for hip arthroscopy?
The best way to know if you’re a candidate for hip arthroscopy is by visiting a sports medicine specialist like our experts at KCOA. We always focus on each individual patient and his or her concerns before creating a treatment plan. During an initial appointment, the physician often asks questions to understand factors such as:
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- What caused your hip pain and where is it located?
- How severe is your hip pain?
- What movements or activities increase your symptoms?
- What are your lifestyle goals?
- How has your hip pain affected those goals?
From there, they will carefully review your X-ray results, and may even order additional tests, such as an MRI, to ensure they understand all the possible causes of your hip pain.
Only after a full diagnosis has been made, can the physician decide whether more conservative treatments will suffice or if you would benefit more from surgery, like a hip arthroscopy, which is usually only preferred when non-surgical treatments do not provide pain relief.
It is important to note that patients with hip arthritis are not candidates for hip arthroscopy, as it has been shown to not be effective at relieving arthritis pain and can often make it worse. Patients interested in learning about surgery for hip arthritis may wish to meet with a hip replacement surgeon at KCOA.
No matter your age, if you have tried other methods and you haven’t yet found relief from hip pain, give our team at KCOA an opportunity to help you. Our physicians are highly trained in their respective fields and can help you determine whether a hip arthroscopy is right for you.
Ultimately, the goal of a hip arthroscopy is to help you return to your active lifestyle. And for athletes, though surgery may seem scary, most everyone returns to the field and continues improving their skills afterward.
Learn more about getting a hip arthroscopy in Kansas City
With the help of our private practice model, KCOA ensures each patient receives the most value possible during their visit.
The core of our success lies in proper diagnosis. An appointment with KCOA includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. From there, we can better understand which sports medicine treatment will work best for you.
For a thorough evaluation of your hip pain or other orthopedic concerns with a KCOA provider, call us at 913.319.7600 or schedule an appointment today.
