The hip is a ball and socket joint made up of the femur and pelvis. The ball portion of the hip joint is the uppermost, or proximal, end of the femur, called the femoral head. The acetabulum is the portion of the pelvis that is commonly referred to as the socket. The labrum of the hip is a rim of cartilage that runs around the rim of the socket or acetabulum. The surfaces of the femoral head and socket are lined by a smooth articular cartilage, that provides for smooth gliding of the hip joint. There is a small band of cartilaginous tissue inside the hip joint, the ligamentum teres, that is most important for stability of the hip in early childhood.
The iliopsoas is a muscle that is commonly referred to as the hip flexor. It runs across the anterior portion of the hip and acts to flex the hip, or lift the knee closer to the chest. The adductors, or groin muscles, are the group of muscles on the inside portion of the thigh and act to pull the thigh medially, in towards the midline of the body. Acting in opposition to the adductors are the abductor muscles, which lift the thigh away from the body, out to the side or laterally. On the posterior aspect of the hip, are muscles which extend the hip, pull the thigh toward the backside of your body, and externally rotate the hip, such as the gluteus muscles and the piriformis.
What are Non-Arthritic Hip Disorders?
Non-Arthritic Hip disorders are generally soft tissue injuries or conditions that can be caused by acute events or chronic/repetitive injuries. Common hip disorders include: labral tears, femoroacetabular impingement (FAI), ligamentum teres injury, internal snapping hip (iliopsoas), external snapping hip (iliotibial “IT” band), loose bodies, and piriformis syndrome.
Labral Tear: Injury to the labrum, or cartilage around the rim of the acetabulum. This can be caused by an acute injury (ie: hip dislocation) or may occur overtime as with FAI – femoroacetabular impingement.
Femoroacetabular Impingement (FAI): This is a general term used to define certain types of bony morphology in the hip. It can be broken down into CAM type, pincer type, or mixed.
CAM impingement – Deformity of the femoral head that causes the femoral head to be “out-of-round”. This can lead to increased friction or irritation of the labrum and articular cartilage – leading to labral tears and cartilage detachment as well as predisposition to acute labral injury.
Pincer impingement – an overcoverage of the acetabular rim or hip socket. This can also pre-dispose you to labral injury, but is less common than CAM type impingement.
Internal Snapping Hip: This is caused when the Iliopsoas Tendon becomes chronically inflamed. When the tendon becomes inflamed, it can snap over the femoral head with movement of the hip, causing a painful snapping or clicking sensation on the anterior or front side of the hip.
External Snapping Hip: Similar to internal snapping hip, in that it is caused by inflammation of a tendon and irritated by movement of the hip joint. However, external snapping hip is caused by inflammation of the iliotibial band, a band of tissue that runs down the outside of the hip. This is commonly associated with Trochanteric Bursitis, inflammation of the Trochanteric Bursa. These conditions can cause painful snapping on the outside of the hip.
Piriformis Syndrome: Compression of the Sciatic Nerve by the Piriformis Muscle. This commonly causes pain that can radiate down the length of the leg and is commonly confused with neurological issues caused by back injuries.
Gluteus Medius Tear: The gluteal muscles are on the posterior and side of the hip and comprise the buttocks. The gluteus medius is the most commonly injured muscle of this group. It runs from the iliac crest to the femoral head and acts to lift the leg away from the body or abduct the hip. It can become damaged or torn with chronic, repetitive motion or from an acute, traumatic event, such as a fall.
How are these disorders/injuries diagnosed?
Accurate diagnosis is made through a combination of thorough patient history, physical examination and diagnostic imaging such as x-ray and MRI. Occasionally we will utilize diagnostic intra-articular injection or CT scan to confirm a suspected diagnosis.
Conservative treatment options include rest, activity modification, physical therapy, NSAIDs and intra-articular injections. Many of these hip disorders can be successfully treated with conservative measures.
When conservative treatment methods fail to improve function and symptoms, surgical options may be considered. Various hip surgeries are demonstrated on our web site. First click on the “Services” tab and then on “Patient Education”.
What is Hip Arthroscopy?
The arthroscopic treatment of hip disorders has gained popularity in recent years as technological advancements have allowed for better visualization of and access to the hip joint. Arthroscopy utilizes a small telescopic camera to visualize the internal structures of the joint and arthroscopic instruments to correct these disorders. This allows for much smaller surgical incisions, less pain, and faster recovery.
Dr. Emblom utilizes a special HANA table for optimal positioning of the patient during surgery. This enables us to be most efficient in the operating room and significantly decrease the amount of time spent under anesthesia.
Labral Repair vs. Debridement: There are different treatment options for labral injuries and the surgeon must make a decision for what the best method of treatment is at the time of surgery. Common treatment for labral injury is repair versus debridement. Repair is just as it sounds, small anchors are inserted into the bone and sutures that are attached to the anchor are used to secure the torn portion of labrum in its normal position to allow for proper healing. Debridement is the shaving or smoothing of the torn portion of the labrum to eliminate further tearing.
Femoroplasty/Acetabuloplasty: Femoroplasty is re-contouring of the femoral head to eliminate CAM impingement. Acetabuloplasty is re-shaping of the acetabulum to eliminate Pincer Impingement.
Iliopsoas Release: This procedure is used to treat internal snapping hip and is exactly as it sounds. The tendon is cut so that the tension of the tightened, inflamed iliopsoas can be released – relieving the snapping sensation associated with this condition and eliminating the pain generating source. The iliopsoas tendon will heal over time, but in a lengthened position, so that it is not predisposed to continued snapping.
Iliotibial Band Lengthening/Trochanteric Bursectomy: IT band lengthening is used for the treatment of external snapping hip and is commonly performed along with trochanteric bursectomy to eliminate lateral hip pain. With this procedure, the arthroscopic instruments are inserted through portals on the lateral side of the hip, and a pattern of small incisions are made in the IT Band to allow for it to lengthen itself and release some of the tension that causes popping and pain. Oftentimes there is no need to examine the intra-articular space with the scope when treating this condition.
Gluteus Medius Repair: In the event of a gluteus medius tear, arthroscopic repair may be possible. With this procedure, small anchors are inserted at the normal gluteal attachment site on the hip and sutures attached to the anchors are used to secure the torn tendon in a position to allow for healing.
Initial Recovery: Most hip arthroscopy procedures allow for immediate weight bearing as tolerated, however we recommend that crutches are used for a minimum of two weeks to protect the surgical site as you begin to regain strength.
Rehabilitation: Our office will provide a specific rehabilitation protocol based on the procedure that is done during surgery. In most cases we recommend that you begin physical therapy 1-3 days post-op and continue 2-3 times per week. The total duration of physical therapy varies based on the extent of the procedure done, however most hip arthroscopy patients are fully recovered within 4 months or less.