Hip Preservation

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The hip is an incredibly complicated area of the body.  When functioning correctly, the hip joint silently facilitates standing, walking, running and sports.  When the hip is not functioning correctly, it can be a debilitating source of pain that prevents individuals from living active, pain-free lives.

The hip preservation team at MOR leads an expert multi-disciplinary approach to treating all conditions related to the hip.  These conditions can occur at any age, including childhood, adolescence, adults and seniors.  Experts at MOR perform cutting edge techniques such as pediatric hip surgery, arthroscopy, femoral osteotomies, periacetabular osteotomies, and surgical hip dislocations to treat a range of disorders.  Our goal is to reduce hip pain, increase function and preserve quality of life without a hip replacement.

Anatomy of the Hip

The hip joint is a “ball and socket” joint. The top of the femur is a round ball (femoral head) that fits inside the concave socket of the pelvis (acetabulum).  The surfaces of the ball and socket are covered in cartilage. The cartilage allows for smooth motion and cushioning.  The socket has a rim of tissue called the labrum.  The labrum functions to deepen the acetabular socket, and acts as a gasket to improve joint fluid lubrication. The hip joint is surrounded by a capsule, ligaments, muscles and tendons. These soft tissues are also critical to the proper function of the hip joint.

Hip Conditions

Numerous factors can contribute to hip pain or hip problems. These include congenital disease, abnormal anatomy, trauma, sports, and overuse.

These commonly result in conditions that might need evaluation by our team, such as muscle strain, tendinitis, bone deformities, labral tear, cartilage injury, or arthritis.  The expert team at Midwest Orthopaedics at Rush is able to treat all conditions that cause hip pain.

Pediatric Hip Disease may develop in utero, childhood or adolescence. Hip clicks can be diagnosed as soon as the newborn is evaluated by the pediatrician.  If there is a clinical suspicion, our pediatric orthopedic surgeon can counsel patients on early preventative intervention.  Some children may also develop a condition known as Perthes disease which may be a cause of hip or knee pain.  Slipped capital femoral epiphysis (SCFE) is another condition that affects children that may require treatment.

Hip Dysplasia is a medical term for a shallow or deficient hip socket. Symptoms sometimes occur at a very young age, but often does not display any signs or symptoms until late adolescence or early adulthood.  Left untreated, dysplasia can lead to accelerated cartilage wear and early arthritis.  Once the arthritis occurs, the only treatment is a hip replacement. If diagnosed and treated before the arthritis process occurs, a hip replacement can be avoided or postponed.

Femoroacetabular Impingement (FAI) or Hip Impingement is a condition that results in abnormal contact between the ball and socket but also associated with hip labral tears.  The structural abnormalities can occur on the ball (femoral head), acetabular socket, or both.  Left untreated, it results in reduced range of motion, pain, cartilage and labral injury, and early-onset arthritis.

  • Avascular Necrosis
  • Bony Abnormalities
  • Bursitis of the Hip
  • Chondral Lesions or Injuries
  • Detachment of the Hip Labrum
  • Extra-Articular Disorders about the Hip
  • Excessive/Insufficient Torsion
  • Hip Dysplasia
  • Hip Impingement
  • Hip Osteoarthritis
  • Hip Osteonecrosis
  • Knee Related to Hip Problems
  • Labral Tears and Chondral Lesions in the Hip
  • Lumbosacral Issues Impacting the Hip
  • Periarticular Muscle Irritations and Tendonitis
  • Perthes Disease
  • Ruptured Ligament of the Hip
  • Role of FAI and Role of Decompression
  • Synovitis
  • Slipped Capital Epiphysis in the Hip
  • Snapping Hip
  • Tendonopathies of the Hip
  • Version

Diagnosing Hip Pain

An accurate diagnosis is essential to recommending correct treatment.  The specialized team at MOR routinely performs the physical examinations and radiological examinations that are essential in establishing the proper diagnosis.  MOR has all of the radiographic imaging modalities (XRay, CT and MRI scans) available to quickly work up the cause of hip pain.

During the physical examination, information is initially gathered on gait and leg length inequality.  Next, the hip range of motion and muscle strength is examined and compared to the other side.  Additionally, specialized maneuvers are performed to help with the diagnosis. Clicking, popping, or limping may occasionally lead to the diagnosis of hip dysplasia.

Xrays, CT scans and MRI scans are also extremely valuable in diagnosing hip pain.  An xray can reveal a shallow hip socket (dysplasia) or excess bone on the femoral head or acetabular socket (impingement). MRI is useful to evaluate the integrity of the soft tissues, such as cartilage, labrum and tendons.

The MOR facility offers clinicians to perform injections in and/or around the hip joint.  These injections are useful in multiple ways.  If the injection alleviates the source of pain, they help with confirming a diagnosis.  Additionally, if the injection alleviates the pain generator, sometimes this can be helpful in definitively treating certain conditions without surgery.  If there is no relief from injections, other sources of pain – such as the back – need to be considered.

Treatments

  • Anti-Inflammatories
  • Physical Therapy
  • Injections
  • Periacetabular Osteotomy (PAO)
  • Proximal Femoral Osteotomy
  • Surgical Hip Dislocation
  • Arthroscopy
  • Core Decompression
  • Abductor Tendon Repair
  • Direct Anterior Hip Replacement
  • Posterior Hip Replacement
  • Hip Resurfacing

Anti-inflammatories, or non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat mild to moderate inflammation and pain. Inflammation and pain has numerous potential causes including: bursitis, tendonitis, muscular tears, arthritis, labral tears, or synovitis. NSAIDs are often prescribed in conjunction with a physical therapy program.

Physical therapy is a crucial component in our multi-disciplinary team approach to treating hip pain. Therapy aims to strengthen muscles, increase flexibility, maintain range of motion of the joint, and decrease the associated inflammation. Therapy is a sometimes an alternative to surgery, and is a critical component to patient care before and after surgery. Therapy will not heal certain painful conditions (e.g. impingement, labral tear, dysplasia), but with the correct strengthening and activity modification, pain may improve and surgery can be avoided.

Injections in and/or around the hip joint are commonly used to establish a diagnosis, but can also be used as a treatment for certain conditions. Following the injection, pain relief is variable. Some may feel relief immediately, some within two to five days and some patients have no relief. If a patient feels no relief within two weeks following an injection, other sources of pain need to be considered and further testing may be needed.

Periacetabular osteotomy is a surgical procedure to treat hip dysplasia. This involves cutting the acetabulum from the pelvis and repositioning in a more normal location to allow for a better fit of the femoral head.  The hip socket is secured back to the pelvis with screws.  The procedure reduces pain, restores function and prevents further deterioration of the hip joint, thereby increasing the life of the hip joint and avoiding, or postponing, total hip replacement.  PAO is a very successful surgery for improving the longevity of the hip joint and pain in patients who have been diagnosed before extensive injury to the hip cartilage. The youngest candidates for PAO are approximately eleven years of age. Although younger patients, such as adolescents, may have the fastest recovery time, patients up to their 40’s may have significant benefit from a PAO as long as their hips are not too arthritic. Patients with progressive cartilage injury and arthritis may not be good candidates for a PAO.

Femoral osteotomy is a surgical procedure that involves cutting and re-aligning of the femur. The bone is cut at the end close to the hip joint and realigned so that it forms a more normal angle. This creates a more normal joint and biomechanical environment for the hip cartilage.

Surgical hip dislocation is a surgical procedure that involves the dislocation of the hip joint during surgery to facilitate easy access to the inside tissues of the hip joint. It helps your surgeon clearly view and treat abnormalities present deep into the hip joint.  Many procedures can be done through an open or arthroscopic approach.

Acetabuloplasty (rim trimming or decompression) is surgical technique used to address acetabular socket over-coverage, also called a Pincer lesion. Frequently, Pincer lesions are associated with degenerative labral tears. Pincer lesions require bone trimming and fixation of the labrum with suture anchors.

Osteochondroplasty (CAM decompression) is a surgical technique used to address excess bone on the femoral head/neck.  The goal is to create a spherical femoral head and avoid impingement.

Abductor (Gluteus Medius) Repair is a surgical technique used to address an abductor tendon tear. The tendons are sutured back to the greater trochanter of the femur and secured with suture anchors.  The procedure is analogous to rotator cuff repair in the shoulder and can be performed with a scope or open techniques.

Removal of Loose Bodies/Tumors, (PVNS/Synovial Chondromatosis), Chondral Repair/Debridement, Chondroplasty is a surgical technique used to remove loose fragments inside the hip joint from a variety of causes.

Arthroscopy is a minimally invasive approach to hip disease.  Using incisions the size of your fingertips, a small camera can be placed in the hip joint to diagnose and treat conditions such as labral tears, cartilage tears, and FAI.