Hip Impingement: Treatment Options

Hip Impingement: Treatment Options

If a patient is having hip pain due to hip impingement, it may be tempting to try and ignore the pain and hope it goes away on its own. However, hip impingement that is left untreated can progress to a tear of the labrum, damage to the surface cartilage, and even hip osteoarthritis.

Once a diagnosis of hip impingement has been made by a health care provider, the patient may decide to try non-surgical treatment. Physical therapy exercises can help strengthen and stabilize the hip with certain stretches, keeping the hip from getting stiff. Anti-inflammatory medications can help with pain, and sometimes the health care provider will try an injection for pain. Using ultrasound can help make sure the injection gets into the right spot.

If the pain doesn't get any better, then surgery might be the next step. If the patient and doctor decide that surgery for hip impingement is the best option, the goals of the procedure are to smooth down the bony bumps that are causing the problem, and to treat any tears of the labrum or damage to the surface cartilage. One thing to keep in mind is that a patient that has already started developing hip arthritis may not benefit from surgery for hip impingement. This should be discussed with the doctor.

In the past, this hip surgery would require a large single incision and would be considered an open surgery. However, with improvements in technology over the years, hip surgery can be done with a more minimally invasive approach through arthroscopy. Here is a model of a right hip, as if the patient is lying on their back with the head up here and the feet down here. The small circles are the locations of portals where small skin incisions are made. The surgeon uses a small camera and instruments through these portals to do the surgery.

Researchers have found that arthroscopy is better for the patient. Studies show that patients who have arthroscopic surgery feel better and do better after the surgery, then those who had an open surgery with a large incision. They also found that the risk of needing a second surgery is lower.

There are two different positions the patient can be in for hip arthroscopy. The most common is supine, which is lying on their back, face up on a special leg positioning table. However, some surgeons position the patient in lateral decubitus, which means side lying with the injured hip facing up. They will make the small skin incisions and then another incision through the capsule that is surrounding the joint to get inside. A few surgeons have started trying to only go through small incisions in the capsule as well, without making one big one.

Once the surgeon gets inside the joint, they will shave down any bone on the socket side if needed. After that, they will use anchors and sutures to repair the labrum if it is torn. If possible, any surface cartilage would be treated at this time as well. Finally, the surgeon moves to the ball side of the joint. Different instruments are used to clear the area of soft tissue, and then shave down any extra bone so that it doesn't cause any more problems. Once finished, most surgeons will choose to repair the capsule with several sutures to try and keep the hip joint as stable as possible throughout recovery.

For the first few days after surgery, the main goals are to heal the surgical incision. Rest ice. Keep pain under control and keep the surgical leg elevated. Depending on what was done during the surgery, some patients will wear a brace on the hip during the first several weeks of the recovery process. By wearing this hip brace, extreme motion in the hip is limited so that the labral repair and any bony procedure the surgeon did is protected. It also helps the capsule heal.

Patients will likely use crutches for a period of time after the surgery, until their leg is strong enough to walk on their own, as well as to help the joint heal. Physical therapy will start so the patient can learn how to protect the healing tissues and improve motion and early strength in the hip. That way they can learn to walk normally without crutches, and then begin more intense exercise to return to their normal activity. Around three months after surgery, patients can do even more intense activity and then return to sports anywhere from 6 to 12 months after the procedure.