Dr. Levy learned hip arthroscopy and removal of loose bodies in the mid 1990’s, however it is only recently that instruments and techniques improved to the point where arthroscopic surgery offered a reliable and safe option for hip pain and dysfunction.
Two common causes of hip pain are mechanical impingement and labral tears. They often occur together.
Hip impingement, also known as femoracetabular impingement (FAI) is a disorder caused by a lack of room, or clearance, between the head and neck of the femur and the rim of the acetabulum. Due to this lack of clearance, when the hip is flexed, as in many common activities such as running, sitting or bending over, the femur and the rim of the acetabulum rub together, causing significant pain in the joint. As a result of extensive contact between the femur and the acetabulum, the labrum may suffer damage, slowly degenerate, and may even cause arthritis in the hip over time.
Hip impingement is more common in athletic men, and any athletic or strenuous activity may further aggravate pain in the groin area caused by impingement. Remaining in a stationary seated position for extended periods of time may also aggravate the condition.
Patients often complain of pain in the groin after prolonged sitting or walking. Many athletes often describe pain in the groin with deep flexion or rotation of the hip during activity. Occasionally, a popping or clicking in the front of the hip is described. Pain may also radiate along the side of the thigh and in the buttocks. It is important to rule out other causes of pain in this area which may originate in the low back or abdomen.
Treatment of hip impingement/femoracetabular impingement begins with conservative, non-surgical methods. Rest, activity modifications, careful use of anti-inflammatory medications, and a course of physical therapy are often successful in alleviating symptoms. An injection of the hip joint with anesthetic and steroid can also provide some relief, as well as diagnostic information in patients with symptoms which are unresponsive to treatment. When surgery is necessary, femoracetabular impingement can usually be treated with arthroscopic hip surgery.
Hip Labral Tear
The labrum is a layer of fibrous cartilage that lines the rim of the socket in which the ball of the femur sits. This cartilage provides cushioning for the joint and keeps the femur in place. A tear in the labrum can result either from injury or from degeneration due to impingement or other joint conditions.
In some cases, labral tears are not significant enough to cause symptoms and therefore don’t require surgical treatment. But occasionally they can cause symptoms such as locking or “catching” in the joint and pain in the hip or groin area.
Since labral tears are often difficult to detect during a physical examination, your doctor may use magnetic resonance imaging (MRI) to confirm the diagnosis. Normal accuracy of MRI’s for hip labral tears is about 65% and may be increased to 90% with a dye injection. Once the diagnosis is confirmed, arthroscopic hip surgery may be recommended.