Arthroscopy presents predictable approach in management of hip-related disorders

KOLOA, Hawaii — For certain hip-related disorders, hip pain is not always a surgical problem; however, proper patient selection is critical for successful outcomes of hip arthroscopy, according to a presenter at Orthopedics Today Hawaii 2015.

“With appropriate indications and surgical technique, hip arthroscopy is a predictable approach for managing a number of hip-related disorders,” Christopher M. Larson, MD, said here.

Larson said arthroscopic and endoscopic hip procedures are rapidly evolving, but further outcomes are needed to better define the role for these procedures.

Hip impingement is common in asymptomatic patients based on plain radiographs and CT scans, and symptoms need to be consistent with imaging, according to Larson.

Christopher M. Larson

He said good candidates include patients who have intermittent, groin/anterior pain with hip impingement test, as well as those who have pain with sports, torsional, sitting and twisting activities. Patients with pain with straight hip flexion, flexion/abduction pain and limited forward flexion, internal rotation and abduction/adduction are also good candidates for hip arthroscopy.

Poor candidates for hip arthroscopy include those who have posterior hip and lower back pain or vaginal and anal pain, as well as patients with constant aching pain at rest and those who use a cane or assistive device.

Static overload and hip instability or giving-out with extension may indicate significant dysplasia, he said. Patients with primarily, palpable posterolateral pain who walk with a significant limp or who have severely decreased hip range of motion would also be poor candidates for hip arthroscopy.

On plain radiographs, Larson said good candidates show well-maintained joint space on all images of normal or femoroacetabular impingement anatomy. Poorer candidates include those whose radiographs show moderate or severe dysplasia, developmental dislocation of the hip, any joint-space narrowing and severe protrusion. On MRIs, poor candidates show bipolar and femoral head full-thickness degenerative defects.

Larson said the use of dye with an anesthetic can create distension, and the pain may not be accurate in the diagnosis.

With diagnostic injections, he advised to examine and ask patients about relief in the first few hours, not days or weeks, after the injection, as temporary pain relief with an injection can support the hip joint as the pain generator, he said. – by Kristine Houck, MA, ELS

Reference:

Larson CM. Hip arthroscopy. Presented at: Orthopedics Today Hawaii 2015; Jan. 18-22, 2015; Koloa, Hawaii.

Disclosure: Larson is a consultant for Smith & Nephew and A3 Surgical and is a stockholder for A3 Surgical.