Hip

Hip Treatment

Femoroacetabular impingement (FAI)

Femoroacetabular impingement (FAI), also known as hip impingement, is the abnormal growth of one or both of the bones conforming the hip joint, causing increased contact and friction between them.

This can lead to a higher risk of hip osteoarthritis due to the deterioration of the articular cartilage and the labrum.

There are 3 types of FAI:

1. Cam impingement, in which the femoral head is not entirely round and cannot rotate smoothly inside the hip socket (or acetabulum), causing pain in the groin area.

2. Pincer impingement, in which there is bone overgrowth creating a prominent rim covering the femoral head, causing pain when in flexion or rotation.

3. Combined impingement, in which both pincer and cam impingements are present.

Treatment

  • Arthroscopic surgery can be used to treat most forms of FAI. It works by cleaning out any labral and articular cartilage damage, to repair the injury and to preserve the labrum or reattach it, when possible.
  • Pincer impingement, in which there is bone overgrowth creating a prominent rim covering the femoral head, causing pain in flexion and rotation.
  • In some extreme cases, open surgery may be necessary to fully treat the injury.

Labral Tears

The labrum is made of fibrocartilage (or collagen), and surrounds the acetabulum (or hip socket) to provide stability and proprioception when in movement.
Labral tears tend to affect the anterior and superior parts of the hip and are the result of a traumatic injury or the wear and tear of the joint. They are often related to femoroacetabular impingement.

Treatment

  • Conservative management includes anti-inflammatory drugs, physical therapy and intra-articular injections of corticosteroids, platelet-rich plasma (PRP) and hyaluronic acid.

  • Surgical treatment is used for labral repair, debridement, or reconstruction. A hip arthroscopy can be performed as a surgical procedure.

Cartilage Injuries

Chondral, osteochondral and cartilage injuries are the result of tissue degeneration or a traumatic injury. If the injury is extensive and affects all of the cartilage, it is called osteoarthritis (or arthrosis).

Treatment

  • Conservative management. It includes making changes to daily activities, rehabilitation, and injections of corticosteroids, platelet-rich plasma (PRP), and mesenchymal stem cells (MSCs).

  • Surgical treatment. Diagnostic and therapeutic hip arthroscopy is indicated for labral tears and loose bodies, but not for osteoarthritis.

Hip Replacement

Hip replacement surgery is recommended when all other treatment options have failed to relieve pain. The hip joint is fully or partially replaced with an implant made of metal, ceramic, and plastic components.

Types:

  • Partial hip replacement is a procedure to replace only one side of the hip joint, the femoral head. It is only used in older people who are not very active and who also suffer from a femoral neck fracture. It is not usually indicated for osteoarthritis, as it causes great wear and tear on the acetabulum.
  • Hip resurfacing is a procedure to trim and cap the femoral head with a smooth metal cover. It is typically used in active young people and athletes. The main advantage is that it preserves the femoral neck and minimises bone removal, while providing greater stability to the hip joint and requiring a shorter recovery time. The disadvantage is that there is a chance, albeit low, of femoral neck fracture.
  • Total hip replacement is a procedure to replace the entire hip joint with a cemented implant fixed to the bone. The damaged bone and cartilage are removed and replaced with an artificial implant. A hip implant is made up of several components and materials, such as metal, high-density polyethylene, ceramics, and plastic.
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