Is a hip arthroscopy possible?

I had a knee arthroscopy to repair a torn medial meniscus. Now I see they can do this on the hip, too. I’m having some hip pain. Can they do an arthroscope and see what’s wrong?

Hip arthroscopy has actually been around since the late 1980s. As technology has improved, arthroscopy has improved. Hip arthroscopy is easier to do now and less invasive than even five years ago.

Surgeons are starting to narrow down which patients are the best ones to have a hip arthroscopy. It works well for problems inside a joint that has very little arthritis. Any loose pieces of bone or cartilage can be removed with a hip arthroscopy. Tears of the cartilage called the labrum can be identified and repaired.

Other hip conditions investigated and treated arthroscopically include synovial problems, bone lesions, and septic or infectious arthritis. In the future, we may expect to see even more conditions diagnosed and treated arthroscopically.

Research will help show which patients have a good or poor response to this procedure. Patients can be chosen more carefully for a successful outcome.

It may be best for you to start by making an appointment with an orthopedic surgeon. Since some conditions are clearly identified with a physical exam or seen on X-ray, arthroscopy may not be needed at all.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Why do doctors take so many X-rays?

The doctor I saw recently thought the pain in my groin area might be coming from a hip problem called impingement. But after three sets of X-rays and an MRI, it turns out the pain was coming from my lumbar spine. Was it really necessary to take so many X-rays?

X-rays are the key to making a diagnosis of hip impingement. With hip impingement, the head of the femur (thigh bone) bumps up against the lip or rim of the socket. A thin layer of cartilage called the labrum gets pinched in the process causing pain. This problem is often treated with surgery, so the imaging studies from all angles are essential.

There are three main ways X-rays can be taken. Each radiographic view offers a slightly different picture of the hip angle and shape. This information is important in diagnosing hip problems such as impingement.

The first is the anterior-posterior (AP) view. This is the view looking through the patient from the front to back. Second is the lateral view from the side. And third is the frog-leg lateral view.

In the frog-leg view, the patient lies on his or her back. The leg is flexed and abducted away from the body. The hip is externally rotated. The knee is bent so that the foot rests against the other leg. The frog-leg view has been shown to be a reliable way to diagnose hip impingement.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Are Legg-Calve-Perthes disease and a hip labral tear related?

As a child I was diagnosed with Legg-Calvé-Perthes disease. Now at age 33, I have a hip labral tear. Are these two conditions related?

Legg-Calvé-Perthes disease affects the hip in young children. For some unknown reason, the blood supply to the growth center of the hip (the capital femoral epiphysis) is disturbed. The bone in this area starts to die. The blood supply eventually returns, and the bone heals.

Patients with Perthes disease are at risk of having osteoarthritis of the hip later in life. Damage to the labrum, a rim of cartilage around the hip socket is common. Many patients with Perthes disease will need a hip replacement.

The more damage there is with Legg-Calvé-Perthes disease, the more problems occur later. As researchers find out more about these hip conditions, earlier and better treatment may make a difference.

If conservative care doesn’t improve your symptoms in two months’ time, then experts suggest surgery as the next step. The torn or damaged labrum is shaved and smoothed down. More advanced techniques may be required depending on the condition of the hip.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Can an arthroscope be done on my hip to see what’s wrong?

I had a knee arthroscopy to repair a torn medial meniscus. Now I see they can do this on the hip, too. I’m having some hip pain. Can they do an arthroscope and see what’s wrong?

Hip arthroscopy has actually been around since the late 1980s. As technology has improved, arthroscopy has improved. Hip arthroscopy is easier to do now and less invasive than even five years ago.

Surgeons are starting to narrow down which patients are the best ones to have a hip arthroscopy. It works well for problems inside a joint that has very little arthritis. Any loose pieces of bone or cartilage can be removed with a hip arthroscopy. Tears of the cartilage called the labrum can be identified and repaired.

Other hip conditions investigated and treated arthroscopically include synovial problems, bone lesions, and septic or infectious arthritis. In the future, we may expect to see even more conditions diagnosed and treated arthroscopically.

Research will help show which patients have a good or poor response to this procedure. Patients can be chosen more carefully for a successful outcome.

It may be best for you to start by making an appointment with an orthopedic surgeon. Since some conditions are clearly identified with a physical exam or seen on X-ray, arthroscopy may not be needed at all.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Twin boys have identical mishaped hips, but not identical problems!

We have twin boys who are both active in different sports. It turns out that they also both have a slightly misshaped hip. For one boy this has caused all kinds of hip problems, groin pain, and lost playing time on his soccer team. The other boy doesn’t seem affected at all. How come?

With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Femoroacetabular impingement occurs when abnormal hip anatomy is aggravated by repetitive movements of the hip. There could be a slightly off center placement of the hip in the socket or a femoral head that isn’t perfectly round that is contributing to the problem. Or the hip socket may be too deep for the size of the femoral head or the rim of the hip socket is too prominent. Sometimes the angle of the femoral neck is bent or twisted just a tad from normal. There could be a separate piece of bone called the os acetabulum along the front rim of the hip socket. Any of these morphologic changes can lead to impingement.

The labrum, a fibrous rim of cartilage around the hip socket is the most likely area to get pinched. Add repetitive motion and you get repetitive pinching or compression until the labrum starts to fray and tear. No one knows for sure just yet why some athletes with this problem are affected while others seem not to notice a problem. With your sons, it could be there is just enough difference in the shape of one boy’s hip that he is spared the painful loss of motion and function. There could be differences in the degree of pinching that is going on or the tension of the soft tissues, muscles, and tendons around the joint.

Studies show that some high level athletes with abnormal hip joints never develop problems. Who does develop femoroacetabular impingement and how to predict if/when it should be treated are areas where further study is needed.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I dislocated my hip and it popped right back in. What should I do?

I accidentally dislocated my hip this morning. It popped right back in but I am freaked. This has never happened to me before. Should I use crutches? What should I do?

You may be experiencing a condition referred to as hip instability. Hip instability can include subluxation (partial dislocation), complete dislocation, and microinstability. The last classification (microinstability) is just what it sounds like — too much looseness in the joint but without a big enough shift in hip position to cause a subluxation.

Many people with hip instability have a known etiology (cause). It could be from a stretching of the ligamentous joint capsule that helps hold the hip in the socket. Or a tear in the labrum (fibrous cartilage around the rim of the hip socket). If there’s no known history of injury, then the condition is referred to as atraumatic (without trauma) instability.

With atraumatic hip instability, there may not be a specific injury but there is still usually a reason the problem develops. There could be an underlying systemic disease affecting the soft tissues (e.g., Ehlers-Danlos, Marfan, or Down syndrome). Abnormal anatomy of the bones or soft tissues could also contribute to the problem. Whether or not you should be putting weight on that leg after a dislocation event is something many experts debate. Studies don’t show that weight-bearing leads to loss of blood supply to the hip — or even to another hip dislocation. Even so, the best thing is to see an orthopedic surgeon and have him or her take a look at what’s going on. There may be a simple explanation and treatment for the problem.

There may be an anatomical explanation for what happened (e.g., perhaps you have a shallow hip socket from birth or loose ligaments that have gotten overstretched).

Whatever the cause, the goal is to prevent further hip instability (dislocations). You may benefit from a short course of physical therapy. Even with hip capsular laxity (looseness), physical therapy to improve core (trunk and abdominal) strength can be helpful. But the first step remains to find out what’s going on and why this may have happened. Once that information is obtained, the course of treatment will follow.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

My family has a history of hip problems. Is there value in having my hips X-rayed to see if they are okay?

My family seems to have a history of hip problems. We don’t all have the same condition but quite a few have arthritis. Is there any value in going in and having X-rays taken to see if my hips are okay? I don’t have any pain but I’m getting up there in age.

Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis. In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage). When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing problems.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

If you have femoroacetabular impingement, is it inevitable that arthritis will eventually set into that hip?

Is it always the case that if you have femoroacetabular impingement (which I have) that arthritis will eventually set into that hip?

Not necessarily though many individuals with femoroacetabular impingement (FAI) do indeed eventually develop degenerative changes that lead to arthritis. This is most likely to happen in cases of untreated FAI.Let’s define femoroacetabular impingement and talk about how it can lead to osteoarthritis of the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.The cam-type of impingement is the most likely to set up conditions ripe for joint wear and tear. This type occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a tilt or pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface. This abnormal contact between the femur and acetabulum is the leading cause of labral tears and degenerative hip arthritis.Treatment is advised when impingement is painful, limits function, and/or X-rays show potential for joint changes. You may be able to follow a conservative path by modifying activities and carrying out a program of strengthening and stretching exercises. In some cases, surgery is indicated to correct the problem.No one knows for sure who will develop arthritis. Studies are underway to determine how common is the problem and what factors might increase the likelihood of developing arthritis. Your orthopedic surgeon will follow your case and advise you if and when treatment (and what treatment) is appropriate.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I have a labral tear of the hip. What kind of surgery can they do for this problem?

I’ve been diagnosed with a labral tear of the hip. I’m scheduled to see a specialist next week but thought I’d do a little research of my own on the Internet before my appointment. What kind of surgery can they do for this problem?

The labrum is a thin but helpful extra layer of cartilage around the hip and shoulder joints. In the hip, it helps extend the edges of the joint socket to form a deeper cup for the round head of the femur (thigh bone). This helps keep the joint in the socket while still allowing a wide range of movements needed by the leg.Damage to the labrum can result in painful symptoms. Sometimes there is a clicking sensation and the hip can even get locked up if the torn labrum gets caught between two structures of the hip. Loss of hip motion is the outcome of either of these symptoms. There is a chance that the labrum can heal itself but most of the time, surgery to remove the ragged edges of the torn labrum is required. This procedure is called debridement. The surgeon shaves off the ragged edges of the labrum and smoothing the remaining edges.A more extensive surgery called a partial labrectomy may be needed. This involves removing the unstable part of the labrum. Studies show that partial labrectomies have better outcomes when there isn’t damage to the underlying layer of cartilage attached to bone. The success rate drops from 90 per cent without chondral lesions down to 21 per cent for those patients with chondral defects.A newer approach to labral tears is now in use: labral repair. During a labral repair, the surgeon uses stitches and surgical anchors to reattach the torn labrum. Results of labral repairs have not been published yet in English-language medical journals. Most of the research that has been done has been published in European or Spanish-language journals. When valid and reliable tools are available, the results of debridement, partial labrectomy, and labral repair can be compared.Your surgeon will probably go over the various surgical options available to you and recommend the one that will work the best for the type of injury and damage you have.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I didn’t fall or hurt myself that I can remember. How can I find out what’s causing my pain?

How can I find out what’s causing my hip pain? I don’t notice it so much during the day but at night it aches like a son of a gun. I didn’t fall or hurt myself that I can remember. It just started bothering me all of a sudden.

There are many possible causes of hip pain. Often what patients call hip pain isn’t coming from the hip at all. Pain along the outside or back of the hip may not indicate a problem with the hip. True hip pain tends to cause pain along the inside of the leg near the groin.

There are many structures in and around the hip that can be causing painful symptoms. These include the joint itself, the rim of cartilage around the joint (called the labrum), the bursa, ligaments, muscles, and tendons.

Sometimes pain coming from the sacroiliac joint or low back can be referred to the hip. Most of the time, pain in the general region of the hip is caused by the soft tissue structures around the hip. There may be tightness, laxity, impingement, weakness, or poor alignment resulting in hip pain. Less often, fracture, infection, or tumor may be the source of symptoms.

A medical examination may be needed to find out exactly what’s causing your symptoms. Your doctor will take a history, perform some standard tests, and possibly order lab work to look for inflammation or infection.

Based on the results of these tests, further work-up may be advised. A set of standard X-rays may be needed. MRIs or CT scans are reserved for cases where further detail is required to make the diagnosis.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.