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If one watches any sports highlight show, “ACL tears” and “Tommy John procedures” are commonly referenced and understood by the lay public. Although the shoulder, elbow, knee, and ankle are perceived as “sports joints” that are susceptible to athletic injuries, the hip is generally not considered in the same vain. “The hip is usually considered a “geriatric joint” since it commonly breaks or fractures in older patients and is quite susceptible to arthritis,” says Dr. Anil Ranawat of the Sports Medicine Service at the Hospital for Special Surgery in Manhattan. The hip, however, is a commonly injured athletic joint! Common hip injuries include labral, capsule, or muscle tears, cartilage injuries, dislocations, and loose bodies. Chronic conditions such as femoral acetabular impingement (FAI) can also cause hip pain in athletes.
FAI is a disorder that has been popularized by Swiss surgeons taking care of elite athletes, skiers, military recruits, and weekend warriors. The hip is a ball and socket joint, and in this disorder, the ball (or femur) pathologically impinges on the cup (or acetabulum). “The result of this impingement can be a labral tear, cartilage injury, or even early arthritis. The most important part of treating FAI properly is early diagnosis since these patients are often misdiagnosed with an inguinal hernia, sports hernia or other complaints,” adds Dr. Ranawat. Although MRI and CT scans are important diagnostic images, well-performed x-rays or radiographs are even more important. Recently, many theories have been advanced on how best to treat this condition. Potential treatment options include physical therapy, cortisone injections, or, ultimately, surgery. “Arthroscopic surgery is usually the surgery of choice, but in rare cases, an open incision may be necessary,” says Ranawat. Although either technique is effective, patients often prefer the arthroscopic technique since there is less tissue trauma and smaller incisions. The key, however, is not the size of the incision but how well the procedure is performed.
Dr. Ranawat contends that the most exciting aspect of this field is that patients do quite well after these procedures. They return to high levels of function; and are, most importantly, pain-free and oftentimes have increased range of motion. In addition, most of these procedures are outpatient day procedures, i.e. the patient goes home the same day. We also know that “younger, more active patients seem to do better than patients with more advanced disease”. Therefore, early diagnosis and intervention are key. Finally, although we are not certain yet, we hope the proper management of impingement will one day prevent or delay arthritis. As baby boomers continue to stay active in sports, our treatment modalities must also adjust to keep up with them and keep them going for decades to come. Arthroscopic impingement surgery is on the cutting edge of new procedures that will help patients, doctors and therapists alike make the hip more understood!