Femoroacetabular impingement, or hip impingement, has emerged in recent years as a major cause of hip pain and eventually arthritis. Hip impingement means that there is a bony conflict in the hip. This conflict occurs when the hip is brought up into flexion. Activities that involve repetitive hip flexion and pivoting are frequently implicated in the development of hip impingement and tear of the labrum of the hip. Such activities include soccer, hockey, and ballet.
The labrum of the hip is essential to normal hip function. This labrum maintains a suction environment of the hip that allows the joint to be properly lubricated with joint fluid. Without the labrum, the hip experiences higher than normal forces at the joint interface. Many studies have shown that breakdown of the labrum is the first step in developing arthritis. Once the labrum is damaged, the joint surface of the cup of the hip begins to peal up away from the bone.
Using either hip arthroscopy or surgical hip dislocation, Dr. Lyman performs labral repair and reshapes the bones of the hip to correct hip impingement.
The discovery of hip impingement has revolutionized our understanding of hip arthritis. For many years, hip arthritis was known as “idiopathic.” This term indicated that the medical profession did not really understand what caused hip arthritis. Dr. Lyman believes that a large portion of patients that were labeled in the past as having idiopathic hip arthritis actually had the end stage of hip impingement.
Prior to having surgery done for hip impingement, Dr. Lyman recommends that non-surgical options be exhausted. This includes using anti-inflammatory medications, losing weight, doing physical therapy, or having injections.
Anti-inflammatory medications have an important role in the treatment of hip pain. However,
they are not appropriate for some people. If the patient has an ulcer or suffers from chronic
heartburn, anti-inflammatory medications are generally not a suitable alternative. However, some anti-inflammatory medications, such as Celebrex®, can be safely taken by people with stomach problems.
Weight loss plays a significant part in relieving hip pain. For every pound carried, the hip joint
experiences four to eight pounds of increased load. Dr. Lyman encourages his patients to start
by losing 10 pounds. This is an attainable goal for most people. The reward for this loss can be
felt immediately as the strain on the hip joint is decreased by 40 to 80 pounds, depending on the
activity. While 10 pounds sounds insignificant, 80 pounds is a substantial difference.Physical Therapy
Physical therapy can help some individuals with hip pain. By strengthening and stretching the
muscles around the hip, some problems that cause hip pain can be completely resolved. After an
evaluation of hip pain, Dr. Lyman may recommend a six-week course of physical therapy to see if
Hip injections are done on an outpatient basis in the hospital, using x-ray guidance. Two
medications are placed in the hip joint. First, a local anesthetic eases pain in the hip joint for a few
hours. This confirms that the medicine has been placed in the correct location. It also confirms
that the hip is the actual cause of the pain. The second medication is a steroid, which requires two
or three days to begin working. This medication decreases inflammation and pain in the hip joint.
Four injections can be given per year.
Hip arthroscopy is an evolving technology and is new to modern orthopedics. As recently as 10 years ago, the procedure was rarely performed. With the recognition of hip impingement, its use has increased significantly.
Hip arthroscopy is minimally invasive. However, because of the depth of the hip joint within the body, the procedure is a difficult one to master. The patient lies on a special table which is made to pull on the leg. This widens the hip joint and allows arthroscopic instruments to be inserted for the work. Small incisions are made at the skin that allows long, pencil-sized instruments to be placed.
Damaged structures of the hip can be repaired or removed during the surgery. The extraneous bone is removed to prevent future impingement.
HIP DISLOCATION SURGERY
Some patients with hip impingement have such severe disease that minimally invasive surgery is not an option. There are some areas of the hip that can not be reached through hip arthroscopy. To treat such patients, Dr. Lyman uses traditional hip dislocation surgery.
Hip dislocation surgery was developed in the 1990’s by Reinhold Ganz of Switzerland. Prior to his work, dislocation of the hip was thought to endanger blood supply to the hip. Professor Ganz found a safe surgical approach that protected the blood supply. Thousands of these procedures have been performed without damaging the hip’s blood supply.
This procedure is performed through a six-inch incision. The hip is, in essence, taken apart and then put back together. With the hip taken apart, the problems of the cartilage and bone that contribute to hip impingement can be addressed.
Regardless of which procedure is used to address hip impingement, the postoperative course is similar.
Weight bearing is limited for six weeks.
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Lewy Body Journal: Our Family's Experience with Lewy Body Disease e-mail: comments "at" LewyBodyJournal.org Journal Contents Journal Introduction .11. Who Mother Was.22. First Hints of Trouble.33. The Signs Become More Pronounced.54. Back to the Neurologist.75. Aricept and Mother's Quick Decline.86. Columbia Presbyterian Hospital .97. Dr. Jekyll and Mrs. Hyde.118. Living Arrangeme