Hip Impingement Surgery: Can “Hip Impingement” Be Caused by a Low Back Fusion?
Hip impingement surgery has grown by leaps and bounds over the last decade. I’d like to explain why we think the concept isn’t valid through a real life story from this weekend. I was recently contacted by a fellow physician who was diagnosed with CAM impingement. At age 35 he finds himself with significant hip arthritis. Because of his arthritis, a hip impingement surgery wasn’t recommended. However, this physician was concerned about a bone spur on his femur otherwise known in the vernacular as a “CAM” lesion (see above in red). The concept is that this area of bony growth will cause the hip to wear out quickly by putting pressure on the cartilage on the hip socket. A pincer lesion will scrape the cartilage off a hip. However, is this a valid concept?
What if the bone spurs that surgeons believe are damaging the joint are actually protecting the joint? This issue was the topic of a recent research study that watched these bone growths occur in hip patients who later developed hip arthritis and they concluded they were protective of the joint, not causative of arthritis. Huh? You read that right-the bone spurs appear to form like all bone spurs, to stabilize an unstable joint. So why would someone who is an active 35 year old develop hip arthritis? I asked this physician about his low back. It turns out that he had several failed low back surgeries for herniated discs beginning in high school and culminating in a low back fusion in 2004. Now look at the diagram below. His most mobile low back segments (L4-L5 and L5-S1) were fused at a young age and he continued to be an active twenty and thirty something. These forces that would normally be absorbed by his spine have to go somewhere and some of the next joints down are the hip joints.
So is it any wonder that a young guy has arthritis? He’s been loading his hip joints several times as much as the average person for 1/2 of his adult life. However, instead of asking this simple question, the focus was on the angles created by the bone spurs that formed to help protect his joint and whether those pieces should be removed. “Houston, we have a problem…”