Hip Injuries

Hip Anatomy

• The normal hip is a congruent ball and socket joint
• The femoral head (ball) rotates on the acetabulum (socket) to achieve full hip range of motion
• Cartilage lines the ball and the socket to reduce friction between the bones
• The labrum cushions the joint but also acts like a rubber seal or gasket to help hold the ball securely within the socket

What is Femoroacetabular Impingement (FAI)?

• FAI occurs when there is a mismatch between the ball (femur) and the socket (acetabulum)
• Impingement (abnormal contact) occurs when this mismatch within the hip joint leads to cartilage and labrum damage
• Damage to cartilage and the labrum leads to pain, decreased function, and increased risk of progression to arthritis

Watch this video for more information about FAI.

Pincer Impingement

• The acetabulum (socket) is too deep or facing backwards (retroverted) which prevents the ball from clearing the socket during hip movement
• Damage occurs when the femur collides into the overhanging rim of the socket which may lead to labral tearing

FAI Treatment

Key Concepts

• Not all patients with FAI on x-ray will become symptomatic and require treatment
• Many people with FAI have similar x-ray findings on the other hip but do not have symptoms
• The goal of treatment is to decrease pain and increase function by reducing inflammation and optimizing hip and pelvis mechanics

Hip Arthroscopy for Treatment of FAI

• Hip arthroscopy, also referred to as keyhole or minimally invasive surgery, is typically necessary for cases that do not improve with conservative treatment
• The goal of hip arthroscopy is to correct the bony abnormality causing impingement and repair the damage to the labrum and cartilage
• Traction is used to increase space within the joint
• 3 poke-hole incisions are made to place a small video camera and specialized instruments into the hip joint
• Patients return home the same day after surgery
• Patients are on crutches for 3-4 weeks
• Full recovery takes 5 to 6 months and requires PT to restore optimal hip function
• About 1 in 3 patients eventually undergo hip arthroscopy on the other side
• Hip arthroscopy is not effective in patients with arthritis or severe dysplasia

What is Hip Arthroscopy?

• Hip arthroscopy, also referred to as keyhole or minimally invasive hip surgery, is typically necessary for hip pain that does not improve with conservative treatment
• Small incisions are made only big enough to place a small video camera and specialized instruments into the hip joint, trochanteric space, and/or ischial space to clearly diagnose and treat hip pathology

Hip Labral Tear

Proximal Hamstring Tear, Gluteus Medius Tear, Snapping Hip

Watch this video for more information on Hip Arthroscopy for FAI.

Is Hip Arthroscopy right for me?

• Hip conditions often improve with conservative treatment including a short course of rest, anti-inflammatory pain medication, and physical therapy. An ultrasound guided cortisone injection is sometimes necessary for patients with persistent pain.
• If pain continues despite conservative treatment, hip arthroscopy is an excellent treatment option for patients with labral tears, femoroacetabular impingement (FAI), tears of the gluteus medius or proximal hamstring, among other conditions

Gluteus Medius Repair: Anchors are used to fix the torn glut back to the footprint

Posterior Hip Anatomy

• The hamstrings are made up of 3 strong muscles located on the posterior thigh (femur)
• The muscles form tendons on either side which attach to the lower knee (tibia) distally and the posterior pelvis (ischium) proximally.
• The hamstrings assist in bending your knee and straightening your hip

What is a Proximal Hamstring Tear?

Proximal Hamstring Tears occurs when the hamstring tendons that attach to the posterior pelvis rip away from the bone, occasionally taking some bone with it

Common causes:

• Water Skiing
• Running
• Football
• Soccer
• Basketball
• Tennis
• Pickleball

Tears can involve one or both tendons and can be acute or chronic.

Key Concepts

• Not all patients with a proximal hamstring tear require surgery
• Small tears can improve with non-operative treatment
• Surgery is necessary for large tears and for smaller tears that have not improved with non-operative treatment

Gluteus Medius Tears

• Increasingly recognized cause of GTPS (25% of middle-aged women)
• Tears can occur due to an acute injury or can result from repetitive stress and overuse
• Patients present with pain on outside of hip with sleep, standing, and going up and down stairs
• Larger tears can lead to a limp due to weakness caused by the tear

Snapping Hip

• Caused by thickening of the back part of the IT band
• The IT band then snaps across the bony prominence (greater trochanter) on the outside of the hip when moving the hip up and down
• Often can see the IT band snap but can’t hear it
• Bringing the leg across your body also causes pain and tightness

Key Concepts

• Not all patients with GTPS need surgery
• Trochanteric bursitis and snapping hip often improve with non-operative treatment
• Surgery is necessary for large gluteus medius tears and smaller tears that fail non-operative treatment

Operative Treatment for GTPS

• Surgery is typically necessary for large gluteus medius tears or small tears that have not improved with non-operative treatment
• Minimally invasive surgery can be performed either through one small incision in the lateral hip or through 3-4 poke hole incisions with the use of a camera and special instruments
• The damaged trochanteric bursa is removed
• The tendons are reattached to the lateral hip (greater trochanter) with suture anchors
• Patients return home the same day after surgery
• Patients are on crutches for 6-8 weeks
• Full recovery takes 5 to 6 months and requires physical therapy to restore optimal hip and knee function