Hip Bone Spur Removal – Why You Should Avoid It

by Chris Centeno, MD /

hip bone spur removal

I had a patient this week ask me about hip bone spur removal. He had been told by a hip surgeon that this bone spur was causing hip impingement and he would either need to “get this fixed now” or “wait for a hip replacement”. Was this accurate, or was his surgeon confusing the egg for the chicken? The good news is that my patient doesn’t need surgery.

What Is A Hip Bone Spur?

 The hip is a ball and socket joint. In some patients, bone spurs can form. This happens when abnormal pressure on the bone causes it to grow. How did this bone spur get there and is this a bad thing that needs to be removed or a good thing that protects the joint?

In this patient’s case, he has the most common type of hip bone spur called a “pincer deformity”. This means that abnormal pressure on the outside of the hip has caused the socket to grow a bit. Basically, his hip joint had pressure signals on the outside of the existing hip socket and this caused the joint to grow more of itself. To see how this works, check out a video of one of these pincer spurs forming.

About Hip Impingement

The surgeon who saw my patient used the term “impingement”. This brings to mind something that’s too tight, or one part not fitting into another and compressing something. So in its classic sense, hip impingement is when a bone spur puts pressure on the joint. From a surgeon’s point of view, this bone spur is wearing down the joint cartilage and this means hip bone spur removal. However, is that accurate or just fiction? Where did this idea come from?

For a pincer “deformity”, the idea that the bone spur on the hip socket is wearing down the joint is false. This myth seems to have gotten started due to studies that noted that pincer deformity was seen in hips with arthritis. However, to see if this type of bone spur was hurting or helping the joint, we can’t rely on studies that look at the MRI’s of patients at one point in time. We can only rely on studies that look at patients with the bone spur over time. For example, if we noted that cars with bald tires had bad alignment and we knew nothing about how these two things interacted in the automotive world, the first type of association study might lead us to believe that bald tires cause bad alignment! However, if we began to look at cars with bad alignment over time, we would see that it’s the poor alignment that causes bald tires, not the other way around.

So the question is, what happens to patients over time who have this bone spur? Does it damage the joint? Nope. The only study that has looked at this issue over time has shown that in fact, when the hip bone spur is present, it reduces the formation of arthritis and protects the joint. If you’re beginning to think that removing a bone spur may be a bad thing, you’re correct.

How Can So Many Academic Surgeons Be Wrong About Hip Bone Spur Removal?

A Google search of this term shows that many prestigious universities suggest that a hip bone spur causes impingement and it needs to be removed surgically. You would think that’s because we have high-level research studies that compare a real hip bone spur removal surgery to a placebo or fake surgery and then follow the results of these two groups of patients over time. The fact is, not a single medical research study has done this experiment. Regrettably, all of the studies that have been done in this area are low-quality affairs, looking at whether patients who get this invasive surgery report improvement, but without comparing those patients to anything meaningful.

In summary, the recommendation by these academic heavy hitters to go ahead with the surgery isn’t science-based, it’s because this procedure has just become common practice. Regrettably, many of the same academic centers are still recommending meniscus surgery for middle-aged patients, despite excellent high-quality studies showing it’s no better than a placebo procedure or physical therapy. So don’t depend on academic centers for quality advice in the world of orthopedic surgery!

Maybe You Should Just Get The Surgery, “Just In Case”

Patients conceptualize common orthopedic surgeries as no big deal. Sort of like getting a worn out part replaced in their car. Well, that’s not so with this one. First, the surgeon must pull on the hip with 60-100 pounds of force to open the area up for the scope. We’ve seen just this part of the surgery lead to unstable hips as this traction can cause an important stabilizing ligament to be permanently damaged.  Second, one of the biggest nerves of the hip loses function because of the traction and must be electrically monitored during the surgery just to ensure that the nerve isn’t permanently damaged. Third, as a result of the damage done to the hip in the surgery, recovery time is 4-6 months, with most patients not reporting full function until about a year. Finally, the portals created to insert the hip surgery instruments can leave large gaping holes in the fascial coverings of the muscles, a problem we’ve called the “portal syndrome”.

The upshot? Based on the best research we have, that bone spur in your hip is there for a good reason – to protect your joint and prevent arthritis. That’s not to say that the joint might not need a little help, but removing the bone spur is not a smart idea. We treat these patients first by trying to remediate the biomechanical 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.

Wondering what’s up with your hip? Take a minute and watch my video on how to read a hip MRI.

Category: Hip

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26 thoughts on “Hip Bone Spur Removal – Why You Should Avoid It

  1. Margie

    I have bone spurs in my feet. What is the best treatment for that condition?

    1. Regenexx Team

      Margie,
      Treat the cause of the bone spurs. Bone spurs are caused by instability, whether it be lax tendons or ligaments in your feet, or weak stabilizing muscles caused by nerves in your back: http://www.regenexx.com/how-your-back-is-causing-your-bunions/

  2. Linda Cochran

    I have a bone spur near my hip bursa that is causing lots of pain in most of the leg. What is the protocol for this situation.

    1. Regenexx Team

      Linda,
      The most important issue is to determine whether or not the bone spur is indeed the source of pain, as there are other possible explanations for what you describe. Generally speaking removing bone spurs is a bad idea as they form to stabilize an unstable joint, which became unstable from things like ligament laxity due to injury or age, muscle atrophy, nerve issues, or the surgical removal of tissue. It’s a much better idea to treat the instability than to remove what’s been keeping the joint stable because of it. There are rare cases in which they need to be removed, like when they are affecting nerves or severely limiting range of motion. http://www.regenexx.com/blog/what-is-a-bone-spur-2/ http://www.regenexx.com/the-regenexx-procedures/hip-surgery/, An exam would be needed to answer those questions and determine treatment, however, I will happy to ask Dr. Centeno.

    2. Regenexx Team

      Linda,
      I did speak to Dr. Centeno, and he has these questions: Where in the leg? Describe the pain? How was the bone spur diagnosed?

  3. Robert B

    Hello
    My wife has terrible hip pain.
    the MRI says she has bone spurs in bothe hips and the ortho doctor says she has a hip impingement.
    she needs surgery but she just started a new job and doesn’t want surgery.
    She’s in a lot of pain
    what can she do??

    1. Regenexx Team

      Robert,

      Bone Spurs, which are often called Hip Impingement depending on their location are a symptom, not the problem. They are a symptom of Instability, which is what needs to be treated: http://www.regenexx.com/hip-bone-spur-removal/ and https://regenexx.com/blog/bone-spur-pain/ Thankfully, they can be treated: http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

  4. Debbie Brown

    my boyfriend has spurs in his hip.he is in alot of pain.they gave him a cortisone shot.it didnt help him.he can’t sleep at nite.he has tried over the counter pain meds which don’t help.what can he do.

    1. Regenexx Team

      Debbie,

      Unfortunately, cortisone shots escalate the situation. http://www.regenexx.com/hip-arthritis-steroid-shots/ and http://www.regenexx.com/steroid-injection-risks/. Bone spurs form as a way for the body to shore up an unstable joint, so the trick is to treat the cause of the instability, which can be done non-surgically with image guided injections of his own platelets and or stem cells: http://www.regenexx.com/the-regenexx-procedures/hip-surgery/ http://www.regenexx.com/hip-bone-spur-removal/ and https://regenexx.com/blog/bone-spur-pain/

  5. Trevor

    My hips are clicking and the pain radiates down my leg to the shin and ankle area. There is moderate pain in the groin area and outside hip area. I’ve been to an osteopath and the results of the x rays showed mild buttressing or spurs laterally in the femoral head, lateral ace tabular cyst, mild arthritis. Can this be cured without surgery. The clicking is driving me crazy. Suggestions please.

    1. Regenexx Team

      Trevor,
      Unlike arthritis in other joints, Hip Arthritis escalates very quickly. The findings you mention are suggestive of that process; addressing the problem sooner rather than later is very important. Please see: http://www.regenexx.com/hip-arthritis-getting-worse-new-research-says-bone/ Bone spurs form as your body’s attempt to shore up an unstable joint, so identifying and treating the cause of the instability in addition to the arthritis is crucial. If you’d like to see if we can help you avoid surgery, please submit the Candidate form here: http://www.regenexx.com/the-regenexx-procedures/hip-surgery/

    2. Chris Centeno Post author

      Trevor, this radiating pain down to the ankle could also be a pinched nerve in the back, so getting that checked out will be critical as well.

  6. James Hanley

    I had THR in 11/15. I have had 3 x-rays since the THR. The x-rays are showing a bone spur growing in my hip joint. I was wondering what should I do. I have a appointment with Nuclear medicine for a MRI in a few weeks.

    1. Regenexx Team

      James,

      Bone spurs grow as your body’s way of stabilizing an unstable joint. One question would be whether the instability was there all along and causative in the arthritis, or was caused by the surgery itself. But there could be many other things going on. An exam by a Physician trained to track down the source of the problem would be needed. Here are 32 locations where you can get that type of exam. http://www.regenexx.com/find-a-physician/

  7. Taylor

    I had the surgery on my hips to repair my labrum and spurs and have never felt better. Also, this is a highly studied surgery and outcomes and benefits usually outweigh the alternative of suffering. I would recommend this surgery to anyone with FAI.

    1. Regenexx Team

      Taylor,

      Glad it helped you! Actually, there is very little published research about the success rate of the surgery which uses outcome reports from the patient. The point is simply that there are nonsurgical alternatives which are not damaging to the longterm biomechanics of the patient.

  8. Shawn Krehbiel

    My daughter who is 19 did have the bone spur shaved down and labrum cleaned up on her left hip after several different treatments that didn’t help including steroid shots last December. She was released in July to begin training for soccer season. She is still in a lot of pain. What would you suggest?

    1. Regenexx Team

      Shawn,
      It’s important to avoid steroid shots as they kill the local stem cells and breakdown cartilage! If you have a recent MRI you can submit the Candidate form and you’ll receive instructions on how to upload it so we can take a look, which we would need to do to advise. Please see: https://regenexx.com/blog/side-effects-of-hip-labrum-surgery/

  9. Robert J. Stokely

    Thank you for clarifying what, where, and why a hip bone spur is and why it usually forms.. Neither my PCP nor a specialist he referred me to made it clear. I was left with the impression that there were bone fragments and two bone spurs under the cartilage, and that the cartilage was thin due to wear out (I am 87).
    However, last Dec, I fell from my backyard trapeze I’d used for decades, hit hard and inverted, and injured myself (primarily left-side leg and hand. I took a two hour nap, and ceased my regular workouts (3x/wk) for over two months to allow whatever was injured to heal. However, problems that developed in my left hip remained or got worse for several months, so I started using a cane and finally (about Apr 2016) saw my PCP. He said my condition does not justify any invasive surgery, but (at my request) subsequently took two XRAYS and said I have osteoporosis and two bone spurs,(but not where). I subsequently requested to see a specialist. He also took tow X-rays, said my LL cartilage was thin and I have OA. I asked how the right him was, he looked and said it was about the same. I told him I have had no problem at all with that hip join ever. Both doctors offered me pain meds, but I chose to avoid them, and try to minimize pain with the cane and PT.. I often walk around the house all day wi/o the cane and little pain, and I can sleep and rest or set and work without it bothering me. I have often wondered if the fall ruptured one or more bursa, and that is pat of my problem. Any suggestions would be appreciated. Thank you and best regards. Robert J. Stokely.

    1. Regenexx Team

      Robert,
      You are incredible – I think we all want to be able to do that kind of workout at then 86! It’s a very good thing that invasive surgery was not suggested. It is possible that the fall could have injured your back. We’d need to take a look. These are the Physicians who can do the type of exam needed:https://regenexx.com/find-a-physician/ Alternatively, if you submit the candidate form we can explain how you can speak to one of our Physicians first.

  10. Dana

    I was diagnosed with arthritis in both hips as well as a bone spur on my left hip. i’m in severe pain as well as limited range of motion in the left leg. its hard to lift the leg up just to do normal things. i’m in constant pain sitting,standing,walking and bending. its even got to where i feel numbness and tingly feelings through the entire leg. im limping cause i cannot walk right anymore. It is also affecting my left knee.. I am seeing a specialist tomorrow but I am scared that he will say that i need surgery or a cortisone shot which I have very heavy reservations. I have taken tylenol as well as Ibuprofen gels and creams and nothing is working…

    1. Regenexx Team

      Dana,
      Cortisone injections are a net negative as they escalate the situation. We’d need more information through the Candidacy process to see if we can help. For assistance in setting that up, please call 855 622 7838.

  11. heu

    Hi, I have a mri that I would love you take a look at.. I have signs of hip impingement, torn labrum caused by bony spurs but not 100% sure what the problem is as the A and E in the UK said there was nothing wrong with my X ray. Been in pain on my left hip for 4 months and recently tore my right hip about 3 weeks ago.. the injury has also caused my left leg to be an inch longer than my right 🙁

    Please help!

    1. Regenexx Team

      heu,

      We have a Regenexx Clinic in the UK, Algocells, who can take a look at your MRI in a Candidacy review and will likely want to examine your low back as well as your hips. Here’s their website: https://www.algocells.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  12. Oj Guerra

    Seriously??.. I’ve been diagnosed with bone spurs in my left hip and right knee.. X-rays show rather minimal growth or damage..had embryonic stem cell injections.. did absolutely nothing!! Told to try cortisone injections.. told if I improved then it was my hip all along.. well no improvements..only minute relief.. chronic pain daily for over a year.. I say bone spurs are the problem.. stem cells suck.. cortisone sucks.. my alternative arthroscopic or hip resurfacing.

    1. Regenexx Team

      Hi Oj,
      Embryonic Stems are only used for research and are not available for use in treatment. You may be thinking of Amniotic, or Umbilical, or Cord Blood products, but unfortunately, none of those contain live and viable stem cells. The important thing to understand about bone spurs is that they are your body’s way of attempting to stabilize an unstable joint, so determining the cause of the instability, and treating the cause and the symptom would likely be helpful.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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