Your Hips Don’t Lie
Posted 5/23/2017 by UHBlog
Your hips are big and powerful, but that doesn’t mean they’re invincible, especially if you play high-impact sports such as basketball, hockey and soccer. In sports like these where you pivot, cut, twist, run and jump, the hip – which is the largest weight-bearing joint in your body – sometimes takes the brunt of the game.
If hip pain develops and it’s minor enough, often rest and self-care, physical therapy, and/or medications or injections can reduce the inflammation. But if the pain continues, it may be time for something more, says sports medicine specialist Michael Salata, MD.
“Hip impingement and other painful hip conditions may be progressive in nature,” Dr. Salata says. “The longer it goes on, the more likely that there will be damage to the labrum, articular cartilage and other soft tissues surrounding the hip joint. Conservative treatment, while sometimes beneficial, is not always the most prudent course of action if symptoms persist, as joint damage may accrue with time. This may lead to more problems and increase the chance of getting osteoarthritis later in life.”
One of the more promising ways to treat unexplained hip pain is with hip arthroscopy.
According to Dr. Salata, hip arthroscopy is an outpatient surgical procedure that allows an orthopedic surgeon to have a clear view of the hip joint without cutting through the skin and tissue. Instead, two or three incisions about the length of a pencil eraser are made, and a small camera is inserted, which allows the surgeon to access the hip joint and address the symptoms causing the pain.
“Hip arthroscopy is a less invasive technique, and is something we recommend for younger, athletic people,” he says. “After this surgery, you won’t have a long recovery time, and there is less pain and joint stiffness. The healing time is faster, too, than open hip surgery. You can expect to be in physical therapy the next day. In one week, you’ll be on an exercise bike, and by eight weeks, you’ll be running or doing the elliptical.”
Hip arthroscopy treats a number of hip conditions that can cause persistent groin pain and decrease mobility, Dr. Salata says. Among the conditions it treats are:
- Femoroacetabular impingement (FAI) – Extra bone overgrowth – called spurs – can develop on either side of the hip joint, which is a ball and socket joint. If too much bone is on the “ball” side – the head of the femur or thigh bone – that’s called a cam impingement. If the overgrowth is on the “socket” – or cup-shaped acetabulum – that’s known as a pincer impingement. Either condition is painful.
- Dysplasia – Sometimes people are born with a condition where their hip socket is too shallow, which can be seen in gymnasts and dancers, Dr. Salata says.
- Snapping hip syndromes – The tendon rubs across the outside of the joint and becomes damaged from repeated rubbing.
- Synovitis – The tissues surrounding the joint are inflamed.
- Loose bodies – These are fragments of bone or cartilage that have become loose and move around within the joint.
According to Dr. Salata, in the past diagnosing and treating the problem with hip arthroscopy was an issue, but orthopedic fellows are being trained earlier in their careers.
“The learning curve with the hip arthroscopy is steep,” he says. “You’re viewing a three-dimensional structure – the hip joint – as a two-dimensional object on a TV screen. You have to be able to contour the bone. As we have performed more and more of these procedures, it has allowed for refinement of the technique we use. We have done a high volume of these surgeries – over 1,500 cases – and have achieved very predictable and good outcomes for the appropriately selected patients.”
Michael Salata, MD, is an orthopedic surgeon, director of the Joint Preservation and Cartilage Restoration Center at University Hospitals Cleveland Medical Center, and associate orthopedist team physician for the Cleveland Browns. You can request an appointment with Dr. Salata or any other doctor online.