Normal Hip Anatomy
The thigh bone, femur, and the pelvis, acetabulum, join to form the hip joint. The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.
Cartilage Acetabulum “The Socket”
The cartilage cushions the joint and allows the bones to move on each other with smooth movements. This cartilage does not show up on X-ray, therefore you can see a “joint space” between the femoral head and acetabular socket.
The pelvis is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts: the ilium, ischium, and pubis.
The socket, acetabulum, is situated on the outer surface of the bone and joins to the head of the femur to form the hip joint.
The femur is the longest bone in the skeleton. It joins to the pelvis, acetabulum, to form the hip joint.
The upper part is composed of the femoral head, femoral neck, and greater and lesser trochanters.
What is a Labrum?
The acetabular labrum is an elastic cartilage that lines the edge of the acetabulum (socket), providing stability to the joint.
The labrum deepens the socket, holds the joint fluid inside the socket and forms a protective cushion between the acetabulum and the constantly moving femoral head.
What is a Labral Tear?
A tear to the labrum from an injury to the hip (i.e. car accident or a fall to the side) can result in pain usually experienced in the groin area.
How does a labral tear occur?
A labral tear can occur from being worn out over a long period of time, sometimes showing evidence of hip arthritis. A major or a collection of minor injuries (from athletics or heavy exercising) to the hip joint may also result in the tearing of the labrum.
What are common symptoms?
- Pain around the groin area
- Pain along the anterior thighs or buttocks
- A clicking sound or sensation from hip joint
- Limited motion of the hip joint
How do doctors diagnose labral tears?
Although x-rays, CT scans and ultrasounds may aid in the initial diagnosis of the location of pain, an MR Arthrogram is usually needed to verify the presence of a labral tear in the hip joint. The procedure is performed via the injection of a contrast agent such as dye into the hip joint prior to the MR imaging.
How are labral tears treated?
If resting, physical therapy, taking anti-inflammatory medication and/or receiving steroid injections do not cure this hip condition, a non-conservative approach may be needed. The fast evolving technique utilized by orthopaedic surgeons to treat this hip condition is called hip arthroscopy. This surgical approach is minimally invasive and offers a relatively quick recovery period post-surgery.
What is FAI?
Femoroacetabular impingement (FAI) or hip impingement describes a condition in which an abnormally shaped femoral head or acetabulum leads to increased bone-to-bone contact during hip movements. This increased friction may damage either the labrum or the articular cartilage that lines the acetabulum. The 2 types of hip impingements are cam and pincer impingement.
Cam impingement is caused by a non-spherical femoral head or excess bone on the neck of the femur. This abnormality damages the acetabular cartilage, eventually causing a separation between the labrum and the cartilage. The pincer impingement occurs as a result of excessive acetabular coverage or an abnormally angled socket that allows contact between the acetabular rim and the femur.Both impingements may result in osteoarthritis of the hip.
How do doctors diagnose hip impingement?
X-ray image may reveal the excess growth on the femoral head and/or neck as well as the acetabular rim. An MRI may expose the tears of the cartilage or labrum of the hip joint.
What are common signs or symptoms of impingement?
- Pain in the hip or groin area after exercising
- A popping sound from the front of the hip
- Pain along the sides of the thighs and buttocks
How is impingement treated?
- Conservatively (Non-surgical)
Reduce pain and swelling with rest, activity modification, careful use of anti-inflammatory medicationsand/or physical therapy
- Non-conservatively (Surgical)
Hip arthroscopy surgery if patients do not respond to the conservative treatments.
What is Dysplasia?
Dysplasia denotes abnormal development of the hip joint acquired at or before birth. Deformity might mean that the femur is wrongly shaped or that the acetabulum is too shallow to completely cover the femoral head. This leads to increased contact between the bones and ultimately, a breakdown of the articular cartilage and labrum.
Correction of a dysplastic hip requires osteotomy and cannot be treated with arthroscopic surgery.
- Bilateral dysplasia
Both hip joints are affected.
- Unilateral dysplasia
Only one joint is affected.
- Acetabular dysplasia
Acetabular dysplasia is a condition in which the acetabulum (hip socket) of an individual is poorly developed, showing evidence in a shallow acetabulum. Affected children may grow into adulthood unaware of any dysplastic symptoms or deformity. When hip pain arises, acetabular dysplasia can be treated via periacetabular osteotomy surgery to alleviate pain and preserve the hip joint.
What are Common Hip Surgeries?
As a safe and effective alternative to open hip surgery, hip arthroscopy is a relatively new minimally-invasive surgical technique that can be successfully employed to treat a variety of hip conditions. Hip arthroscopy has been relatively slow to develop. It was initially believed to be difficult to perform any meaningful surgery based on the constrained anatomy of the hip joint. Recent developments of new surgical techniques have made arthroscopic hip surgery easier to perform and thus more effective.
- What happens during Hip Arthroscopy surgery?
2 to 3 small incisions (about ¼ – ½ inches long) are made on the hip joint for the insertion of a surgical instrument called the arthroscope. The arthroscope is a long and thin camera that allows the surgeon to view the inside of the hip joint. A fluoroscopy guides the arthroscope to guarantee accurate insertion. Other surgical instruments employed during the surgery are a variety of shavers that the surgeon uses to remove frayed cartilage or labrum.
- What is the recovery time for Hip Art?
Following surgery, patients are on crutches for maximum 2 weeks. Then they typically assume physical therapy treatment following the removal of sutures. Each patient is different but complete recovery may take up to 4 or 5 months.
- Who is a candidate for Hip Art Surgery?
If conservative methods of treatment fail a patient experiencing hip pain from either a labral tear or femoroacetabular impingement, hip arthroscopy may be needed. Active patients with hip pain, who after thorough physical and diagnostic examination, exhibit adequate cartilage to be preserved by hip arthroscopy surgery are good candidates.
“Studies have indicated that 85-90% of hip arthroscopy patients return to sports and other physical activities at the level they were at before their onset of hip pain”.
Hip Resurfacing or bone conserving procedure replaces the acetabulum (hip socket) and resurfaces the femoral head. This means the femoral head has some or very little bone removed and replaced with the metal component. This spares the femoral canal. Find out more about Hip Resurfacing from the following options.
Total Hip Replacement
Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) to eliminate pain and restore joint movement.
What is Arthritis?
Hip arthritis represents inflammation to the hip joints. The inflammation is caused by damage to the articular cartilage located at the surface of the hip joint. In the early stage of arthritis the sole cause of pain is the synovial inflammation. As the disease progresses, the friction between the bones of the joint (due to heavily worn down cartilage) causes the majority of the pain.
Types of arthritis (a 100 different types exist)
Osteoarthritis, also known as degenerative joint disease, remains the most common form of arthritis and is found mostly in older people. Due to a lifetime of overuse, acquired injuries to the hip joint or genetic factors, this disease causes the destruction of the cushioning cartilage meant to protect joints from bone-to-bone contact. Affected individuals will experience pain caused by the friction between the underlying bones as well as a reduced range of motion. Usually, this form of arthritis involves one or more large weight-bearing joints such as the hip or knee.
- Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic inflammatory disease that may concurrently involve many different joints in the body. RA is a problem that arises when the immune system attacks its own joints, which results in joint inflammation. Patients present with swelling, warmth, redness and stiffness in or around joints. The inflammatory response further leads to joint damage.
Who can be affected by arthritis?
Arthritis is a very common disorder affecting as many as 70 million Americans. Although it occurs more commonly in older persons, adolescence and children are not exempt from arthritis. A history of major injuries, obesity, and having relatives who have developed this disease are all factors that increase the risk of developing osteoarthritis
What are symptoms of arthritis?
The symptoms of arthritis consist of swelling, redness or heat in the joint, pain in one or more joints for more than 2 weeks, and a limited range of joint movement. The skin, lungs and heart can experience inflammation as well.
How do doctors diagnose arthritis?
Doctors utilize the patient’s medical history, a physical exam and medical imaging of hip to diagnose the disease.
Commonly used over-the-counter anti-inflammatory drugs relieve pain and swelling. Some examples are:
- Physical therapy to strengthen muscles and joints
- Intra-articular steroid injection into the hip joint
- Activity modification
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