Hip athroscopy rates have exploded in the past decade. Many believe that these surgeries are small “fix it jobs” when a tear in the hip labrum is discovered on MRI. However, what if hip impingement surgery results weren’t all they were cracked up to be? What if the surgery had negative consequences?
Hip arthroscopy is a surgery that’s usually used to treat a torn labrum which is the lip around the socket of the ball and socket hip joint. It’s also used to treat impingement, or when a bone spur on the hip socket causes the joint to pinch. 15 years ago the surgery pretty much didn’t exist, but today it’s become commonplace. There are however a few problems with the concept.
Given that hip labrum tears or impingement are often found on an MRI and blamed for why the hip hurts, for that concept to be valid, these MRI findings would only be found in patients with hip pain. In fact, any small number of people walking around with these findings and without a problem could cause an unnecessary surgery if something else were to cause pain in the hip. Which regrettably turns out to the case, as research shows that an awful lot of people have hip labrum tears or impingement and have no hip pain. In addition, new research has shown that at least one type of bone spur that used to be thought responsible for hip impingement, actually doesn’t cause impingement. In fact, it forms to prevent arthritis, not cause arthritis. Hence, this calls into question the whole reason to perform surgery in these patients. Why remove a bone spur that formed to protect the joint? Wouldn’t that be bad medicine?
The new study sought to look at strength and balance deficits in hip arthroscopy patients. The researchers looked at a single leg stance test in 34 patients 1-2 years after hip arthroscopy and 34 matched control subjects who never had surgery. The hip arthroscopy group demonstrated significantly more bending of the hip and knee inward (hip adduction and knee valgus) when trying to perform a single leg squat. In addition, when the operated limb was compared to the opposite side non-operated limb, it was weaker in holding up the pelvis.
The upshot? Whether the above deficits were caused by hip arthoscopy or were there before the surgery isn’t clear. However, what is apparent is that hip arthroscopy patients who get surgery have problems stabilizing the joint. Was this instability the cause of the hip labral tear and the bone spur that was supposedly causing the problem that needed surgery? If the hip was unstable to begin with and we remove the bone spur that formed to try to stabilize and protect the hip joint, does that make the hip more unstable? Of course it does! IMHO, most hip arthroscopy surgeries are unnecessary and likely don’t help hips.!