Orthopaedic Surgery and Sports Medicine services for the hip joint
Femoroacetabular Impingement Syndrome (FAIS)
Femoroacetabular impingement syndrome (FAIS) is a triad of clinical signs, symptoms, and imaging findings that result in significant hip pain and dysfunction. Depending on presentation and extent of injury, both nonoperative and operative treatment options may be recommended. Surgery is typically performed in an arthroscopic fashion and involves labral treatment along with acetabular and femoral resurfacing as needed. A postoperative rehabilitation program follows including individualized physical therapy and return to sport assessment.
Hip Instability
Hip instability has numerous causes that ultimately result in sensation of hip pain or unsteadiness. Appropriate diagnosis is critical for symptomatic improvement. Treatment is then targeted to the underlying pathology and may include therapy, injections, and/or surgery.
Snapping Hip
Snapping hip syndrome is the audible click or pop that occurs as the hip is taken through a specific range of motion. Traditionally it was thought to be due to inflammation of the iliopsoas tendon or iliotibial band, though a variety of causes have now been identified. In cases that cause hip pain or functional limitations, multiple management options exist depending on severity.
Hamstring Injury
The hamstrings are integral for lower extremity function and may be injured along a spectrum depending on the location and extent of injury. While strains will typically heal over time, large tears may require surgical repair. Early identification and treatment will usually lead to the best results.
Gluteal Injury
Similar to the hamstrings, the gluteal muscles are key for hip function (particularly abduction - lifting the hip to the side). As stabilizing muscles, even small tears can cause severe hip pain and dysfunction. These injuries are often equated to rotator cuff tears of the shoulder. Partial tears may be treated with therapy and injections, while full tears typically require surgical fixation.
Trochanteric Bursitis
Inflammation (bursitis) of the bursa between the greater trochanter and iliotibial band can cause severe lateral hip pain, leading to downstream problems with the leg. Treatment may include anti-inflammatories, therapy, injections, or surgery.
Hip Arthritis
Hip arthritis may be due to a variety of causes and can result in significant hip pain and stiffness that limits routine activity. While initial management is typically nonoperative, hip replacement can offer substantial pain relief and improved mobility in persistent or severe cases.
Deep Gluteal Syndrome
Deep gluteal syndrome is characterized by posterior hip pain that results from sciatic nerve compression in the deep gluteal space. Multiple structures may cause compression, and diagnosis is key for successful management.
Sports Hernia
Sports hernia, otherwise known as “athletic pubalgia,” describes groin pain in athletes that may be due to a number of structural injuries in front of the hip. Precise anatomical diagnosis is critical for treatment, which may include physical therapy, injections, and/or surgical repair.
Hip Arthroscopy and Hip Preservation Surgery
Hip joint disorders can be a source of significant pain and dysfunction, limiting performance for general daily activities, work, and athletics. In this video we discuss the field of hip preservation surgery, including background education on hip anatomy, joint disorders, and treatment options.
Hamstring Repair
This is a technique video describing how to perform an endoscopic proximal hamstring repair. The endoscopic approach is a minimally-invasive technique that can limit postoperative complications, decrease nerve injury rates, and improve technical visualization for anatomic repair while potentially allowing for a faster recovery.
Hip arthroscopy has become the preferred surgical approach for managing femoroacetabular impingement (FAI) syndrome, a condition causing hip pain and dysfunction due to abnormal contact between the femoral head and acetabulum. This minimally invasive technique offers advantages over open surgery, including smaller incisions, reduced blood loss, faster recovery, and shorter hospital stays. Patients typically experience groin pain, often radiating to the thigh or buttock, aggravated by hip flexion, internal rotation, and adduction. Diagnosis involves a thorough physical exam (including provocative tests like the FADIR test) and imaging studies (X-rays and MRI).
The arthroscopic procedure typically uses three to four portals around the hip joint, guided by fluoroscopy. These allow insertion of the arthroscope for visualization and specialized instruments. The most prevalent surgical aspect of hip arthroscopy for FAI is currently labral repair, a shift from the previously more common debridement. This involves using specialized sutures to reattach the torn labrum, restoring its structural integrity and function. Simultaneously, bony impingement is addressed with femoral osteoplasty (reshaping the femoral head-neck junction) or acetabuloplasty (reducing acetabular overcoverage), depending on the patient's anatomy.
Surgical precision is crucial. Accurate portal placement prevents neurovascular injury. Advanced imaging (fluoroscopy, intraoperative navigation) enhances accuracy. Surgeons require a comprehensive understanding of hip anatomy and biomechanics for optimal results. Specialized instruments (shavers, burrs, radiofrequency devices) allow precise bone and soft tissue management.
While post-operative outcomes generally show significant pain relief and improved hip function, with high patient satisfaction and return to previous activity levels, long-term success depends on several factors. A more common long-term complication is the potential for progressive arthritis and the subsequent need for a total hip arthroplasty (THA) later in life. This risk can be influenced by factors such as the patient's age, pre-existing joint conditions, and the extent of the initial articular damage.
Several factors influence the prognosis after hip arthroscopy for FAI. Positive prognostic factors include younger age, less severe cartilage damage at the time of surgery, successful labral repair, accurate preoperative diagnosis, and diligent adherence to the post-operative rehabilitation program. Negative prognostic factors, on the other hand, include older age, significant pre-existing cartilage damage (e.g., osteoarthritis), failure to achieve a successful labral repair, incomplete bony impingement correction, and poor patient compliance with rehabilitation. The presence of multiple negative factors may increase the likelihood of persistent pain, reduced functional outcomes, and the need for future surgical intervention.
Potential complications, although less frequent with experienced surgeons, include infection, bleeding, nerve injury, heterotopic ossification (HO), and recurrent impingement. Meticulous surgical technique and post-operative care are crucial to minimize these risks.
Post-operative rehabilitation follows a structured progression: initial (pain management, wound care, gentle range of motion), intermediate (strengthening, improved mobility), and final (return to activities). Recovery timelines are individual, depending on factors such as age, overall health, and the extent of the surgical procedure.