The hip joint is a ball-and-socket structure, and when a bone spur develops on either the ball or the socket, this is called a femoroacetabular impingement (FAI), or a hip impingement. With an impingement, the concept is that you have a misshapen ball or socket that is somehow damaging or creating tears in the labrum, a fibrous rim around the lip of the hip socket designed to add stability by helping to keep the femur securely within that socket. Surgeons like to go in and surgically reshape all of this, cut off the bone spurs and cut out or rebuild the torn pieces of the labrum, but is this a good idea? Let’s step outside of the surgeon’s world for a moment and take a look at the reality of hip labrum tear surgery results.
You might think that because these surgeries are so common and because your surgeon is recommending them, we must have lots of research that supports them. You would be wrong! What we actually do have is quite a bit of research that sheds some light on the reality of these surgeries and the lack of evidence to support them. I’ve shared many of these studies on this blog over the years, and now we have another study to discuss-one that reviews all of the prior research.
18 Studies on Surgery for Hip Impingement Reviewed
This recent study from April of this year was published in the prestigious journal Osteoarthritis and Cartilage. The authors reviewed 18 different studies on hip impingement surgery, and these were the best available studies they could find in this particular area. First worth mentioning is that the authors noted that most of the studies had a high risk of bias, meaning the surgeon performing the study wanted to see his or her hypothesis work. There isn’t any way to remove this bias; it’s just there. Is that automatically a bad thing? Depends on where you sit.
The authors concluded the following: “Although evidence supports improvement in symptoms after surgery in FAI, no studies have compared surgical and non-surgical treatment. Therefore no conclusion regarding the relative efficacy of one approach over the other can be made. Surgery improves the alpha angle but whether this alters the risk of development or progression of hip OA is unknown.” The authors went on to conclude, “This review highlights the lack of evidence for use of surgery in FAI.” What this means is that we don’t know if this type of surgery is going to reduce your likelihood of getting arthritis, even though, in my direct experience, that’s what many of my patients have been told. Given that the reduction in the likelihood of getting arthritis and needing a hip replacement is a huge motivator for the procedure, not knowing if this will really happen is troubling.
So maybe you’re saying, This is all fine and good, Dr. Centeno, but my hip really hurts, so I think I’ll go ahead and take my chances with the surgery. Why not? Well, there are a slew of why nots to consider, so grab a shovel, and let’s dig through a few.
The “Why Nots” of Hip Impingement and Hip Labrum Tear Surgery
Certainly, in some extreme cases, surgery may be the only option; however, in my experience, this isn’t the majority. I have covered many reasons and studies over the years (a few links follow) that should clearly answer this question for the majority: Why would you skip hip impingement surgery and what do hip labrum tear surgery results actually look like?
- Hip labrum tear surgery results are poorer when the patient has hip arthritis, even if the arthritis is very minimal. This study also concluded that, in addition, arthritis worsened in 6 in 10 patients despite the surgery.
- Hip labrum tears seen on MRI may not be the cause of hip pain and, in fact, may just be incidental findings due to normal wear and tear. Labrum tears are also common in patients without pain, so having a labrum tear on MRI and having hip pain doesn’t automatically mean that it’s the tear that causing your pain. Many other things cause hip pain, most of these problems are not inside the hip joint.
- A recenet study showed that hip impingement surgery to remove bone spurs is really no better than doing nothing at all. The hip-socket bone spur is a good example. One study concluded that the bone spur isn’t causing the arthritis, but may actually be forming to protect the joint from arthritis. So if these spurs are leading to less arthritis, doing nothing may be the better option.
- Removing bone spurs that form as a result of instability may remove the one thing keeping the joint stable. When the hip joint becomes unstable, bone spurs form to stabilize the joint. So what happens when we saw off the bone spurs? Instability returns! And the joint now has the added stress of having to deal with the trauma of surgery.
- Physical therapy exercises may be able to help you fix your hip impingement and avoid surgery. The tilt of your pelvis can impact hip impingement. Tilting your pelvis forward results in more impingement and tilting it backward results in less impingement, according to one study.
The upshot? Why do we continue to saw off bone spurs, which protect our joint and provide stability, and cut out labrum tears that are part of normal wear and tear? Especially when none of this may even be the cause of hip pain? Now that you know the reality of hip impingement and hip labrum tear surgery results, you have a choice to make. Do you step back into that surgeon’s office or walk away? I know what I would do.