How is impingement diagnosed?
Medical imagery in the form of x-ray and magnetic resonance imaging (MRI) are crucial for diagnosing femoroacetabular impingement. X-ray can reveal an excess of bone on the femoral head or neck, and on the acetabular rim. An MRI can reveal fraying or tears of the cartilage and labrum.
Conservative (Non-Surgical) Treatment for Femoroacetabular Impingement
Non-surgical treatment should always be considered first when treating femoroacetabular impingement. Femoroacetabular impingement can often be resolved with rest, modifying one's behavior, and a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing the pain and swelling in the joint.
If pain persists, it is sometimes necessary to differentiate between pain radiating from the hip joint and pain radiating from the lower back or abdomen. A proven method for differentiating between the two is by injecting the hip with a steroid and analgesic.
The injection accomplishes two things: First, if the pain is indeed coming from the hip joint the injection provides the patient with pain relief. Secondly, the injection serves to confirm the diagnosis. If the pain is a result of femoroacetabular impingement, a hip injection that relieves pain confirms that the pain is from the hip and not from the back.
Hip Arthroscopy in Treating Femoroacetabular Impingement
What happens during a hip arthroscopy?
Hip arthroscopy, or a "hip scope," is a minimally-invasive procedure. The use of an arthroscope means that the procedure is done using 2-3 small incisions (approximately 1/4-1/2 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.
Aiding other advances in arthroscope technology, 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.
The location of the incisions and instruments for the procedure
The instruments include an arthroscope, which is a long thin camera that allows the surgeon to view the inside of the joint, and a variety of "shavers" that allow the surgeon to cut away (debride) the frayed cartilage or labrum that is causing the pain. The shaver is also used to shave away the bump(s) of bone that are responsible for the cartilage or labral damage.
In addition to removing frayed tissue and loose bodies within the joint, occasionally holes may be drilled into patches of bare bone where the cartilage has been lost. This technique is called "microfracture" and promotes the formation of new cartilage where it has been lost.
The procedure is normally done as an "outpatient" surgery, which means the patient has the surgery in the morning and can go home that same day. Normally, the patient is under regional anesthesia. Under regional anesthesia, the patient is numbed only from the waist down and does not require a breathing tube.
What is the recovery time associated with hip arthroscopy?
Following the procedure, patients are normally given crutches to use for the first 1-2 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 3-6 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.
Who will benefit from hip arthroscopy and what are the possible complications?
Following a combination of physical and diagnostic exams, patients are deemed suitable for hip arthroscopy on a case-by-case basis. 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 85-90% 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.
Provided by Sruan Coleman, MD, PhD
For more information on hip injuries, visit the Orthopaedic connection website of American Academy of Orthopaedic Surgeons