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Activity-related groin pain is key in the selection of patients for hip arthroscopy
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KOLOA, Hawaii – With recent growth and potential to improve pain and function, orthopedic surgeons need to carefully select patients who are candidates for hip arthroscopy, according to a presenter here at Orthopedics Today Hawaii 2018.
“Hip arthroscopy is [the] fastest-growing procedure in sports medicine, with [a] 35% annual growth rate. It [is] still the only area in orthopedics that is seeing double-digit growth on a year-to-year basis,” Charles A. Bush-Joseph, MD, said.
For patient selection, he said it is key to identify patients with activity-related groin pain.
“Everything you do on your physical exam maneuver is to identify if this [is] an intra-articular problem or an extra-articular problem. The patient you want to be able to identify is one who has the intra-articular problems. What we are trying to identify [is] if the patient has a round ball that fits into a round socket.”
Bush-Joseph said MRI is indicated in all patients. Additionally, he will use CT scans for patients who have complex boney deformity as a surgical planning tool, as opposed to making a diagnosis, to have a better idea of the potential correction.
The critical element in patient selection, he said, is the offset angle and the most important number to remember is the alpha angle. The alpha angle, whether 50° or 60° is used, is the breakpoint insurance carriers are going to look at and studies are going to report. He said these are the critical elements that indicate patients who have femoacetabular impingement that warrants boney treatment, as 70% to 75% of patients will have these abnormal indices as asymptotic patients.
Among the red flags in the selection of patients for hip arthroscopy are patients who have hip dysplasia or capsular ossification. Additionally, he said the literature has shown there are some patients who have inferior outcomes from hip arthroscopy. These patients include women, especially women older than 45 years; patients with Tonnis grade 1 or above or lower joint space width; patients with higher BMIs; smokers; workers’ compensation cases; and patients with psychiatric disease. – by Kristine Houck, MA, ELS
Reference:
Bush-Joseph CA. Hip arthroscopy 2018: What can you accomplish? Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.
Disclosure: Bush-Joseph has no relevant financial disclosures.