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.