What Is Hip Arthroscopy?

Currently, hip arthroscopy is a hot topic in the world of orthopedic medicine. Hip arthroscopies are becoming more popular as they are minimally invasive and may delay the need for hip replacement. Physical therapy prior to hip arthroscopy and after hip arthroscopy is a critical component to ensure advances in quality of life and function. So, what is hip arthroscopy?

Hip arthroscopy is a surgical procedure intended to perform minimally invasive procedures on specific hip conditions. The number of hip arthroscopy procedures has increased by 400 percent during recent years.⁸ Hip arthroscopy can be utilized as a treatment for acetabular labral tears, femoral acetabular impingement (FAI), and removal of loose bodies or bone spurs. With advances in technology and medicine throughout the 21^st century, physicians have determined not all hip pain is coming from the back. Thorough physical examination, diagnostic skills, and advanced imaging have allowed for improved diagnosis of hip disorders and successful management of these disorders, including both physical therapy and hip arthroscopy.

FAI vs Labral Tear

• Femoroacetabular Impingement (FAI): FAI is an abnormal bony change either to the head of the femur (CAM lesion) or the acetabulum of the pelvis (pincer lesion). While CAM lesions are more common in males and pincers in females, some people may have both show up on an x-ray.⁸ Symptoms of FAI can include, but are not limited to, decreased or painful knee to chest, crossing of the legs, or hip rotation ranges of motion, pain with prolonged sitting, or driving, or pain with rising from a chair. Most patients with FAI note pain in the groin, but some individuals may also describe “c-sign” pain, utilizing a c-shape with their hand around the outside of their hip. Sometimes, pain in the low back, buttock, or sacroiliac joint may also be present. Patients rarely recall a trauma that started their hip pain – it just gradually worsens over time. 
• Labral Tear: An acetabular labral tear is when there is an injury to the cartilage and tissue in the hip joint. There are four common causes of labral tears: FAI, congenital dysfunction, trauma and hyper-mobility. Symptoms can include groin pain, popping, clicking, grinding or feelings of instability. A thorough subjective history of pain, coupled with physical examination findings, can indicate labral dysfunction.

Imaging and Treatment

X-Ray or MRI can be utilized to provide images of the hip joint and surrounding soft tissues. The use of an MRA (magnetic resonance angiography) is occasionally used based on physician preference. The information provided by the imaging helps the physician to determine if there is a bony morphological change or condition in the hip and the extent. But the presence of FAI or labral tear does not mean patients need hip arthroscopy! There are 43 percent of patients who have FAI or labral tears on imaging, but have NO symptoms.⁷

• Physical Therapy (PT): PT can help with differential diagnosis of FAI. Just because a CAM or pincer lesion and labral tear shows up on imaging does not mean that is from the origin of the patient’s pain. Physical therapy can help tweak out other issues and figure out the source of the pain. Treatment may include balance, small and large muscular strengthening, as well as mobility training; with a focus on hip stabilizers, glute activation, strength and core stability. This allows for normalization of movement patterns to translate to activities of daily living and overall improved quality of life. This could prevent the need for surgical intervention.
• Surgery: Surgery should be utilized after failure of conservative management, which can include physical therapy, injections, etc. Processes are improving to determine which individuals with FAI are excellent candidates for hip arthroscopy surgery. Physical therapy typically follows surgical intervention to rebuild strength, movement patterns and improve functional independence.

Hip Arthroscopy Prevention

To help with differential diagnosis of hip and to improve outcomes for functional independence, Athletico Physical Therapy offers the Hip Preservation Program. Although all hip arthroscopies cannot be prevented, Athletico’s Hip Preservation Program can help individuals improve mobility and function to reduce the risk of these injuries and continue recreational/professional activities.

Do you have hip pain? Contact Athletico for a free assessment. The Athletico team will take a look at your pain or soreness complaint and provide recommendations for a treatment plan.

If you are interested in learning more about Athletico’s Hip Preservation Program, including hip arthroscopy risk assessment, please email hip@athletico.com.

Schedule a Free Assessment

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Daivajna, S., Bajwa, A., & Villar, R. (n.d.). Outcome of arthroscopy in patients with advanced osteoarthritis of the hip. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113970.
2. Hip arthroscopy. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/treatment/hip-arthroscopy/.
3. Hip arthroscopy. (n.d.). Retrieved from https://orthop.washington.edu/patient-care/articles/sports/hip-arthroscopy.html.
4. Kremers, H. M., Schilz, S. R., Houten, H. K. V., Herrin, J., Koenig, K. M., Bozic, K. J., & Berry, D. J. (2017). Trends in utilization and outcomes of hip arthroscopy in the united states between 2005 and 2013. The Journal of Arthroplasty, 32(3), 750–755. doi: 10.1016/j.arth.2016.09.004
5. Pietrzak, J., Donaldson, M., Kayani, B., Rowan, F., & Haddad, F. (2018). Hip arthroscopy: a narrative review of the current literature. Journal of Musculoskeletal Disorders and Treatment, 4(3).
6. Truntzer, J. N., Shapiro, L. M., Hoppe, D. J., Abrams, G. D., & Safran, M. R. (2017). Hip arthroscopy in the united states: an update following coding changes in 2011. Journal of Hip Preservation Surgery, 4(3), 250–257.
7. Vahedi, H., Aalirezaie, A., Azboy, I., Daryoush, T., Shahi, A., & Parvizi, J. (2019, May). Acetabular labral tears are common in asymptomatic contralateral hips with femoroacetabular impingement. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30444756.
8. Young, J. L., Wright, A. A., & Rhon, D. I. (2019). Nonoperative management prior to hip arthroscopy for femoroacetabular impingement syndrome: an investigation into the utilization and content of physical therapy. Journal of Orthopaedic & Sports Physical Therapy, 49(8), 593–600. doi: 10.2519/jospt.2019.8581