5 Questions About Hip Arthroscopy for Hip Impingement

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Hip Arthroscopy for Hip Impingement

Hip arthroscopy for hip impingement or a labral tear is more invasive than you’ve been led to believe. Add to that a laundry list of side effects and the wealth of research showing poor results, especially in patients with arthritis, and you have to wonder why anyone chooses to go through it. If you are considering hip arthroscopy, we have answered 5 questions about hip arthroscopy for hip impingement that should provide more clarity as you make your decision. First, let’s get familiar with hip anatomy.

The Anatomy of a Hip

The hip is a ball-and-socket joint. The ball forms the head of the femur and when functioning optimally fits nicely into the socket, a bowl-shaped depression in the hip bone called the acetabulum. The acetabulum is lined with cartilage to cushion the joint, and there is a fibrous lip around the socket called the labrum. All of these structures can be affected when there is a hip impingement.

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1. What Is Hip Impingement?

Hip arthroscopy for hip impingement is a common indication for the surgery. The medical term for this is femoroacetabular impingement (FAI). This means there is a bone spur either on the socket (pincer impingement) or the ball (cam impingement) of the joint or on both. A bone spur is just an extra growth of bone.

Surgeons typically advise that bone spurs be removed because early studies showed that the spur was associated with hip arthritis. But the key thing missing from the studies was how they are associated. A large study specifically looking at impingement and osteoarthritis answered the how by showing that the spur formed to protect the joint and that patients who had it developed less arthritis over time. So instead of causing arthritis, the bone spur protected against it! This means that by cutting out the bone spurs, the surgeon is removing the body’s natural response to protect itself from arthritis. Hip bone spur removal is a bad idea!

The labrum can also become torn or frayed, which when combined with hip pain is also considered an indication for arthroscopy. During arthroscopy the torn piece of the labrum can be cut out or an attempt can be made to rebuild it. Hip arthroscopy surgeries for labral tears when hip arthritis is also present also tend to be unsuccessful.

2. Does a Hip Impingement Cause Pain?

If an impingement or a labral tear was a common source of hip pain, we would expect that patients without hip pain wouldn’t have these findings and patients with hip pain would be the only patients who have them.

The traditional orthopedic thinking that leads to surgery is that a small number of us are born with hips that tend to “impinge,” and this extra wear and tear can rapidly lead to arthritis. As a result, if someone has an MRI showing hip impingement and also has hip pain, he or she must need an invasive surgery.

However, what if your pain had nothing to do with the hip impingement? What if I told you that the research shows that just about everyone, whether they have pain or not, has a hip impingement? A Norwegian study looked at 2,081 young adults with X rays of their hips. Surprisingly 97.1% of the men and 98.6% of the women had at least one X-ray finding of hip FAI! Yes, almost everybody had hip FAI!

So almost everyone has some degree of hip impingement and most of us never even know it because we never have pain. So if we have hip pain, and the results of our MRI show a hip impingement, is it the impingement causing our hip pain or could it actually be something else? Do we really want to undergo an invasive hip arthroscopy if impingements are also common in patients without pain and arthritis? The answers, respectively, are, yes, it could be something else causing your hip pain—perhaps the problem isn’t really in your hip—and, no, we should look for alternatives.

3. If I Have Arthritis with My FAI: Should I Have a Hip Arthroscopy?

No. But, unfortunately, many hip arthroscopy patients we’ve evaluated after failed surgeries had evidence of arthritis before their procedure, even though surgery on patients with hip arthritis has been shown time and time again to be unsuccessful.

In a new study, researchers looked at the records of all of the patients from one hospital who had hip arthroscopy for hip impingement. Two groups were established: a group whose records reflected arthritis or bone involvement and a control group whose records showed no evidence of this. The study concluded that surgery for a torn labrum with impingement will be significantly less successful with the presence of any arthritis or bone involvement. This is true even in mild cases of arthritis.

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4. What Are the Side Effects of Hip Arthroscopy?

There are many side effects to hip arthroscopy. We all conceptualize that arthroscopy is “minimally invasive” because it’s less invasive than an open surgery. However, hip arthroscopy is much more invasive than knee arthroscopy. Here are some side effects:

  • Worsening arthritis: In this study, the authors found that even the smallest evidence of arthritis at the time of surgery dramatically reduced outcomes with almost 6 in 10 having worsening arthritis as a result of the surgery. This seems to hold up based on the fact that the bone spurs often removed by hip arthroscopy surgery for impingement are no longer able to protect the cartilage.
  • “The Portal Syndrome”: This is chronic pain from the portals used for hip arthroscopy. The portals are the tunnels created so they can put the ball-point-pen-sized hip arthroscope into the joint. We’ve seen nerves become entrapped in these portals, and to relieve the pain, we’ve used platelet lysate (growth factors from a patient’s own blood platelets) to hydrodissect (via an ultrasound-guided injection) the small nerves in the portals.
  • Nerve damage: During arthroscopy major traction has to be pulled on the hip to allow room for the hip arthroscopy instruments. How much traction? An awful lot! So much so that the major nerve of the leg and thigh (the femoral nerve) frequently loses the ability to transmit signals during the surgery.
  • Metal debris: We’ve seen it in almost all joint replacements that have any type of metal component, but metal debris is also being left behind in arthroscopies. In this case a team of researchers took a metal bone shaver of the type used in hundreds of thousands of joint arthroscopy surgeries annually. They shaved some bone pieces and then looked under a microscope and saw a significant amount of metal debris created by the bone shaver. They also noted that these metal particles killed off some joint cells. In addition, they caused the synovial cells of the joint to produce nasty toxic cytokines that could harm the joint.

5. Are There Alternatives to Hip Arthroscopy for Hip Impingement?

Yes! We treat hip impingement patients first by trying to remediate the biomechanical hip issues that caused the bone spur to form. You would be surprised at the damage bad biomechanics can do and equally surprised at how easy it is to correct. Second, we support hip-joint cartilage health by injecting highly concentrated platelets or stem cells into the joint.

The upshot? Hip arthroscopy has been the fastest growing orthopedic surgery for over a decade. Prior to that, outside of a few procedures, hips couldn’t be operated on without a hip replacement. While this may seem like a medical advance, unnecessary hip arthroscopies, because they are labeled as “minimally invasive,” are being divvied out like Band-Aids. We hope our questions will lead you to the right decision if you are considering hip arthroscopy. As the very least, if you have arthritis with hip impingement, please look for other alternatives. Also think twice about this invasive surgery if you don’t have arthritis. If you have to have it, at least make sure you exhaust your nonsurgical treatment options as described above, which consist of more than just a steroid shot in the hip!

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10 thoughts on “5 Questions About Hip Arthroscopy for Hip Impingement

  1. Art Holmberg

    I am 70 with moderate to severe arthritis, a bone spur with narrowing of the joint. The pain from all of this was becoming more than I was willing to take. However, I did not want surgery. Having had both shoulders repaired in the past I was looking for something other than another invasive procedure. I did my research and consulted one of your Dr’s in Tulsa, Dr. Movva. He felt I would be a good candidate based on my MRI and that I had not had any procedure or injection done to my right hip.
    Just prior to my Stem Cell procedure the pain in my hip caused me to walk with a severe limp. At times my hip would just stop functioning causing me to loose my balance. I would reach for the nearest door, chair or person to keep me from falling. I would have to regain my stance and try to move forward cautiously.
    That was 4 months ago, so far my progress has been very good. Two months later, at Christmas, I was playing basketball with my son and grandkids. I wasn’t running, but I was enjoying the fun.
    Today or 4 months later the progress has continued. I still watch what I do, stretching everyday and continue to exercise. My walking has improved, if I do to much I know it. I am very thankful to have found this treatment.

    1. Regenexx Team Post author

      That is really wonderful news! So many lessons contained in your words…thank you for sharing them!

  2. Bryan Small

    I am only 49,but my left hip has really deteriorated due to my football days…I was diagnosed with degenerative disc disease..My x ray showed almost bone on bone where my cartilage should be…My Dr. said I need a hip replacement. A friend of mine told me about you guys,I hope you can help me.

    1. Regenexx Team Post author

      Given the risks involved in hip replacement surgery and the need for revision surgeries going forward, all conservative and less invasive options should be tried first. The relationship between your DDD and hip problem needs to be looked into as that relationship is a common one. Tests can be done to identify whether lack of hip cartilage has anything to do with your hip pain at all, or whether your back is the actual pain generator. https://regenexx.com/the-regenexx-procedures/hip-surgery/ https://regenexx.com/blog/common-causes-of-chronic-hip-pain-infographic/ We’d be glad to take a look, or if you’d like to speak with one of our physicians about your case, please fill out the Regenexx Candidate form. https://regenexx.com/blog/knee-replacement-questions/ (article applies to all joint replacements)

  3. Scott glibowski

    I’m 39
    And just has hip arthroscopy to repair a torn labrum and significant impingement that when I worked out would cripple me. Turns out the tear was 4 cm long and shaved a significant portion of bone. I’m 3 days out and hoping was the right decision for my future

    1. Regenexx Team Post author

      While not the way we would have treated this issue, with you, we hope for a good result!

  4. Sharon Brown

    My x-ray showed “moderate congenital convex prominence of the anterior-superior head/neck junction region of the proximal femur could be a source of cam-type femoroacetabular impingement.” Is “cam-type” the same as a bone spur? I have lived with a bone spur in one knee for years. The hip does cause me pain at times, seems to be getting worse. Would PRP or prolotherapy work for this hip problem?

    1. Regenexx Team Post author

      Yes, a CAM type FAI diagnosis describes a type of hip bone spur. Please see: https://regenexx.com/blog/hip-bone-spur-removal/ Bone spurs form as your body’s way of attmepting to stabilize a joint. So the treatment needs to correct the instability. We treat this issue first by trying to remediate the bio mechanical hip issues that caused the bone spur to form and secondly by helping the joint cartilage remain healthier by injecting highly concentrated platelets or stem cells into the joint. Please see: https://regenexx.com/blog/hip-impingement-exercises-can-you-fix-it-with-therapy-and-avoid-surgery/

  5. Anna

    Hi I’m 24 and have a labral tear I have tried steroids injection with no improvement and now I am going to have hip arthroscopy. I have been suffering with all the symptoms of it for the past 2 years. Has anyone had this surgery ?

    1. Regenexx Team

      Hi Anna,
      Steroid Injections are a net negative as they break down tissue, however, when they don’t help at all, it could indicate that your pain may be coming from something other than the Hip Labral tear. Please see: https://regenexx.com/blog/hip-labrum-stem-cell-procedure/ and https://regenexx.com/blog/hip-labral-tear-recovery-without-surgery/ We have a Regenexx location in the UK. Please let us know if you would like to be seen.

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