The Hip Preservation Center at Vincera brings together internationally-recognized hip and core specialists that are dedicated to hip pain diagnosis, treatment, and prevention. Our experts include orthopedic and general surgeons, acupuncturists, physiatrists, pain management physicians, physical therapists, yoga and nutritional specialists, and massage therapists.
We have specialized programs for hip problems, including labral tears, hip impingements and a wide spectrum of other hip conditions in men and women of all ages. It is important to see a trained health care professional if you are experiencing hip pain. For many hip conditions, early intervention is crucial to hip preservation, slowing or reversing their progression.
Besides focusing on your particular hip condition, we also emphasize strengthening your core muscles in order to enhance support of your hips. Your treatment plan is also tailored to your specific clinical needs. This ensures that you receive the individualized care that is essential to your recovery and return to pain-free athletic activities, optimum performance, and health.
The hip joint is a “ball and socket” joint located where the thigh bone (femur) meets the pelvic bone. The upper segment (“head”) of the femur is a round ball that fits inside the cavity in the pelvic bone that forms the socket, also known as the acetabulum. The ball is normally held in the socket by very powerful ligaments that form a complete sleeve around the joint capsule.
Both the ball and socket are covered with a layer of smooth cartilage, each about 1/8 inches thick. The cartilage acts as a sponge to cushion the joint, allowing the bones to slide against each other with very little friction. Additionally, the depth of the acetabulum (socket) is increased by a fibrocartilaginous rim called a labrum that lines the rim of the socket and grips the head of the femur, securing it in the joint. The labrum acts as an “o-ring” or a gasket to ensure the ball fits into the socket.
Overview of Hip Injuries
The ball and socket joints of your hips are very stable. When they are healthy, it takes great force to hurt them. However, playing sports, running, overuse or falling can all sometimes lead to hip injuries. Over time, other types of conditions related to the hip can also cause problems.
Finally, certain diseases can also lead to hip injuries or problems. Particularly common in older people, osteoarthritis can cause pain and limited motion. Also, osteoporosis of the hip weakens bones so much that the can break easily.
Common symptoms of hip conditions include:
- Pain or discomfort on the inside of the hip joint
- Pain or discomfort on the outside of the hip joint
- Groin pain
- Thigh or buttocks pain
- Clicking or popping of the hip
- Limited range of motion of the hip joint
- Pain in hip after injury
- Increased hip pain after activity
To schedule an initial evaluation at Vincera’s Hip Preservation Center, call 267-592-3200 or email us.
Types of Injuries
The labrum, the fibrocartilaginous rim that lines the rim of the hip socket and secures the “ball” or head of the femur in order to provide additional stability, can tear. These tears can be caused either by a sudden injury or repetitive use . Symptoms include:
- pain deep in the groin on the side adjacent to the affected hip
- clicking or locking sensations in the hip
- instability of the hip
- stiffness in the hip joint
Labral tears are commonly found in athletes, including runners and hockey, soccer and football players.
Frequently, labral tears are often thought to be groin pulls. Orthopedic, Core Muscle, and Radiologic/Musculoskeletal Imaging Secialists at Vincera work closely together in order to diagnose complex injuries and create treatment plans, often in a single visit that would otherwise take weeks and trips to multiple offices.
Femoro-acetabular impingement (FAI) occurs when the ball (head of the femur) does not have its full range of motion within the socket (acetabulum of the pelvis).
Impingement refers to grinding between abnormal bumps on the ball and/or socket of the hip.. This causes both pain, damage to the cartilage/labrum, and a decreased range of hip joint motion. There are two types of FAI impingements:
- CAM impingement: This most common form of FAI results from excess bone that has formed around the head and/or neck of the femur, otherwise known as "cam"-type impingement.
- Pincer impingement: FAI also commonly occurs either due to the overgrowth of the socket rim or, otherwise known as "pincer"-type impingement, or when the socket is angled in such a way that abnormal impact occurs between the femur and the rim of the acetabulum.
- Psoas Impingement, or Internal Snapping Hip. When the ilio-psoas tendon outside of the hip joint becomes irritated and tightens, it can either
- snap across either the hip ball or socket, or
- compress and either crush or tear the labrum that surrounds the rim of the hip socket.
In this congenital condition, the pelvis’ hip joint socket, or acetabulum, does not completely cover the hip ball—otherwise known as the head of the femur. To make up for these structural deficiencies, the body often forms more labrum tissue—the cartilage that surrounds the rim of hip socket. But due to the excessive pressure on this labrum tissue that results from the incomplete hip socket coverage, it often tears. There are two types of hip dysplasia:
- Anterior acetabular dysplasia—the front of the hip “ball” is not completely covered by the hip socket, and
- Lateral acetabular dysplasia—the side of the hip “ball” is not completely covered by the hip socket.
If untreated, the condition can lead to early arthritis.
The angle at which the femoral neck—which links the head (or ball of the hip) to the socket—meets the shaft of the femur is called version. There are two types of version abnormalities:
- Femoral anteversion: The femoral neck is rotated too far forward and the parts of the hip joint to the front, including the labrum and capsule, can be overloaded. Snapping can occur.
- Femoral retroversion: The femoral neck is rotated too far backwards and, as a result, the labrum can be crushed.
Transient synovitis of the hip—also called toxic synovitis or irritable hip—is a temporary inflammation of the inner lining of the synovium, the loose connective tissue that forms a capsule around the hip joint. The most common cause of hip pain in children, it usually affects children between the ages of three and 10, and primarily boys.
Synovitis usually lasts seven to 10 days, although some children experience symptoms for several weeks.
Hip instability can range from severe dislocations to subluxation, in which the hip joint slides out of place but quickly realigns itself. Instabilities can be caused by traumatic events, such as motor vehicle accidents and athletic injuries, or be chronic as the result of either congenital factors or overuse.
External Snapping Syndrome
Snapping hip syndrome or sensation can occur when muscles or tendons slide over one of the hip’s bony protrusions. Usually it is caused by a tightness in these muscles and tendons, and most often affects people, such as athletes and particularly dancers, who repeatedly have to bend at the hip. It is more common among young athletes because muscle tightness often accompanies growth spurts.
Snapping hip can lead to bursitis—a swelling of fluid-filled sacs that act as cushions for the hip joint. The Hip Center at Vincera specializes in conservative treatment options for snapping hip to reduce your risk of developing bursitis.
At bone joints throughout the body, bursae—small, jelly-like sacs—act as cushions to minimize friction between bones and soft tissues, such as muscles and tendons. One of these bursae, the trochanteric bursa, covers the bony point of the hip. When this bursa becomes inflamed, patients can experience hip pain.
Hip & Core Muscle Injuries
Understanding the interactions between Core Muscle Injuries and Femeroacetabular Impingement is at the forefront of sports medicine research and Vincera physician are leading the way. The Hip Preservation Center of the Vincera Institute is the only place where you can get surgery for both hip and core muscle injuriesat the same time. Concurrent core muscle injuries and symptomatic hip impingement is not uncommon and probably remains underdiagnosed. We have established a clear relationship between the way the core muscles pull and how the femur (“ball”) sits in the hip socket. For example:
- When someone has pain from hip impingement, the core muscles often tighten so as to decrease the range of motion of the hip and protect against the painful motion. These subconscious changes can lead to secondary core muscle injuries.
- Fixing an impingement (and allowing increased range of motion) within the hip can cause dramatic changes in the forces applied to, and orientation of, the core muscles.
- Changes in the forces applied by the muscles (by either injury or strengthening) can have profound impact on whether or not there is hip impingement (i.e. the bones of the hip grind against each other).
The experts at The Hip Center at Vincera Institute will hold your hand through every step of this process. Your visit will likely include:
- MRI, ultrasound, or other diagnostic imaging at Independence Imaging, conveniently located within the Vincera Institute’s building
- Functional Assessment
- History and Physical
- Other Diagnostic Procedures
- Meeting with Physician(s)
- Consultations with Experts (may include physical therapy, acupuncture, yoga therapy, nutrition, behavioral counsel, anesthesiology/pain management, massage therapy, radiology, neurosurgery, chiropractic, etc.)
Treatment & Procedures
In consultation with you and your medical professionals, The Hip Center team will recommend the treatment and procedures most appropriate for you and your condition so you can get back to pain-free activities as quickly as possible. Each treatment protocol is personalized to your diagnosis, history and prognosis. Here are some examples of treatments your team may suggest:
- activity modification and anti-inflammatory medications
- physical therapy
- therapeutic injections and procedures
- specialized yoga protocol
- heat/ice therapies
- massage therapy
Finally arthroscopic hip surgery is an option for such conditions as labral tears, hip impingements and hip instability.
Hip arthroscopy, or a "hip scope," is a minimally invasive procedure. The use of an arthroscope means that the procedure is done using two to three small incisions (approximately 1/4- to 1/- inch long) rather than a more invasive "open" surgery that would require a much larger incision. These small incisions, or "portals," are used to insert the surgical instruments into the joint.
Meanwhile, the flow of saline through the joint during the procedure provides the surgeon with excellent visualization. The surgeon is also aided by fluoroscopy, a portable x-ray apparatus that is used during the surgery to ensure that the instruments and arthroscope are inserted properly
Patients who respond best to hip arthroscopy are active individuals with hip pain, where there exists an opportunity to preserve the amount of cartilage they still have. Patients who have already suffered significant cartilage loss in the joint may be better suited to have a more extensive operation, which may include a hip replacement.
Studies have shown that 85 percent to 90 percent of hip arthroscopy patients return to sports and other physical activities at the level they were at before their onset of hip pain and impingement. The majority of patients clearly get better, but it is not yet clear to what extent the procedure stops the course of arthritis. Patients who have underlying skeletal deformities or degenerative conditions may not experience as much relief from the procedure as would a patient with simple impingement.
As with all surgical procedures, there remains a small likelihood of complications associated with hip arthroscopy. Some of the risks are related to the use of traction. Traction is required to distract and open up the hip joint to allow for the insertion of surgical instruments. This can lead to post-surgery muscle and soft tissue pain, particularly around the hip and thigh. Temporary numbness in the groin and/or thigh can also result from prolonged traction. Additionally, there are certain neurovascular structures around the hip joint that can be injured during surgery, as well as a chance of a poor reaction to the anesthesia.
Following the procedure, patients normally use crutches during the first one to two weeks to minimize weight-bearing. A post-operative appointment is normally held a week after the surgery to remove sutures. Following this appointment, the patient normally begins a physical therapy regimen that improves strength and flexibility in the hip.
After six weeks of physical therapy, many patients can resume normal activities, but it may take three to six months for one to experience no soreness or pain following physical activity. As no two patients are the same, regular post-operative appointments with one’s surgeon is necessary to formulate the best possible recovery plan.
Other Treatment Options for Certain Hip Conditions
Periacetabular osteotomy (PAO) is a procedure in which the surgeon makes several cuts around the acetabulum, or hip socket, in order to allow the socket to better cover the ball of the hip joint. While the bones heal, screws hold the socket in place. In some cases, the surgeon may also cut into the ball, or femoral head, to enhance the hip’s alignment. source: hipdysplasia.org/adult-hip-dysplasia/adult-treatments
In addition, any related labral tears might have to be repaired arthroscopically.
If the version, or angle at which the femoral neck meets the femur’s shaft, is too extreme, excessive version may have to be corrected with an osteotomy—a surgical procedure in which the femur is broken and realigned.
For more information on hip injuries, visit the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.
Prevention & Preservation
Rehabilitation, Pre-habilitation and Prevention Programs
At The Hip Center, our clinicians ensure you are provided with a comprehensive and tailored treatment plan to enable a speedy recovery. Examples of treatment plans that may be ordered are:
Pre-habilitation Programs - Being healthy before surgery enables you to recover more quickly after surgery. Depending on your history and diagnosis, your team may recommend “pre-hab” which may consist of physical therapy, exercise physiology, yoga, nutrition, acupuncture, behavioral medicine or chiropractic visits.
Day of Surgery Physical Therapy – Your medical team is focused on the most appropriately aggressive plan to quicken your recovery. When you are discharged from the ambulatory surgery facility, you may begin physical therapy immediately, which may consist of cold laser therapy, therapeutic activities, education and ice compression.
Physical Therapy and other Post-operative Plans - Your physical therapy and other treatment plans will begin as soon as your physician clears you. Your comprehensive plan may include physical therapy, massage therapy, yoga therapy, nutrition, exercise physiology and behavioral medicine. Prevention Programs – While we like working with you, we do not want you to have a recurrence. We work with patients closely on lifestyle and other prevention programs to educate you so you can lead a healthy life free of hip problems.
To schedule an initial evaluation at Vincera’s Hip Preservation Center, call 267-592-3200 or email us.