Hip Preservation Helps Pain and May Prevent Replacement
It used to be that a young athlete with hip pain and cartilage wear had to quit playing sports, put up with the aches and then wait 30 or so years until he or she was old enough for a hip replacement.
“The reason why we don’t put hip replacements in young people is because there’s an expiration date on them — they’re metal and plastic, and they’re going to wear out,” explains Andrea Spiker, MD, a UW Health orthopedic surgeon who leads the new Hip Preservation Program. “But now that we have hip arthroscopy, we can address pain caused by femoroacetabular impingement and labral tears and get patients back to being active, pain-free and hopefully to the point where they’re never going to need a hip replacement.”
Arthroscopy allows surgeons to view the inside of the hip with a small camera so they can repair torn cartilage and resect abnormal bone formation without a large incision. It’s a mainstay of the relatively new field of hip preservation. “Hip preservation means doing everything possible to prevent or delay total hip replacements,” Spiker says.
Abnormally shaped hip bones can cause problems long before old age. Femoroacetabular impingement (FAI) is when extra bone develops along the “ball” or “socket” of the hip’s ball-and-socket joint, preventing a perfect fit. Friction can then tear the labrum, which is the soft tissue around the socket. “When you have this bony lesion and the bones meet and rub, you get labrum tears and cartilage loss, and those two things are painful,” she says. Over time, the condition can lead to osteoarthritis, which is defined as the breakdown of the cartilage that cushions the joints.
“Femoroacetabular impingement is becoming more common in the young athletic population,” Spiker notes. “We see it a lot in hockey, soccer and lacrosse players due to the torques they’re putting on their hips. The running theory is it develops when the growth plates are still open during adolescence.”
Hip dysplasia, which more frequently affects females, is when the cup-shaped socket (also known as the acetabulum) doesn’t fully cover the ball of the femur (thigh bone). “The ball of the femur bone can then slip out of the hip socket, which causes a lot of pain and can cause early osteoarthritis,” she explains.
Treating Hip Pain
Spiker shares these tips for treating hip pain:
Get an expert opinion. Hip pain is complex: Sometimes back pain presents as hip pain, and knee pain or groin sprains can actually be caused by the hip. A doctor or physical therapist should be able to identify the source of your pain.
UW Health’s new Hip Preservation Program is staffed by a multidisciplinary team, including orthopedic surgeons, non-operative sports medicine and rehabilitation doctors, physical therapists and athletic trainers. “It’s rare to have such a multidisciplinary group all weighing in on patients who have hip problems,” Spiker says. “It’s something that we have here at UW that you won’t find at a lot of other places in the region.”
Try nonsurgical treatments first. “You don’t have to have surgery. In some cases you can just strengthen the muscles around the hip, especially the core,” Spiker says. New research in the field of hip preservation has recently found that patients who have less spine motion are more likely to have hip pain, so focusing on spine flexibility could help, she says. Cortisone injections can also temporarily reduce pain and stiffness.
Consider a hip preservation procedure. When appropriate, an arthroscopic procedure can save you years of pain, and it’s better to take care of it before your hip causes problems in other joints. For femoroacetabular impingement, the surgeon removes the extra bone and repairs the labrum, and this can usually be done through an arthroscopic surgery. For hip dysplasia, the surgeon repositions the bones for better coverage of the femoral head (the “ball”) through a larger incision.
Be patient during recovery. “If you undergo a hip scope, it’s a difficult recovery process,” Spiker notes. “I also do shoulder and knee scopes, and it’s nothing like those. The hip is a deep joint, there’s a lot more muscle covering it, and you have to put a patient in traction in order to get the instruments in because it’s a big weight-bearing joint with very little space between the acetabulum and femur.” Expect to spend one to two weeks on crutches and then another four weeks taking it easy while your hip tissues heal. You’ll also work with a physical therapist to recover motion, strength and athletic function.
Replace your hip if needed. Sometimes total hip replacements later in life are unavoidable. “Total hip replacement is one of medicine’s greatest accomplishments, and it’s the only way to definitively treat osteoarthritis,” Spiker says.
Date Published: 02/23/2018