10 years ago, no one had hardly heard of hip arthroscopy. Operating on the hip was limited to a few superficial or muscle procedures and a hip replacement. However, in the last 5 years, the ability to operate on the inside of the hip using the same general type of tools used in knee arthroscopy has exploded. A recent study says that hip arthroscopy rates increased some 600% from 2006-2010. However, while researchers are still trying to figure out the hip FAI surgery success rate, this morning I’d like to go over why it may not be as good as we think:
1. Hip arthroscopy is unlikely to help if you’ve lost half or more of your hip cartilage. This is concerning, as we still see many patients get the procedure performed when they’ve lost hip cartilage from arthritis.
2. Based on a new study, the bone spurs often removed by hip arthroscopy surgery for impingement are protective of the cartilage
3. The hip arthroscopy portal syndrome. This is a problem we’ve observed where the surgical holes (portals) come apart and don’t heal, leaving the patient in pain and with a new problem.
4. Poor outcomes based on new hip surgery research when the procedure is used to treat labral tears. In one recent study, about half the patients had a poor outcome.
5. Everybody has FAI! FAI is a medical term for hip impingement. This means that the patient has bone spurs which are causing damage to the cartilage and leading to arthritis. As above, the most common type of bone spur treated is actually protecting and not harming cartilage! In addition, a few studies have shown that an awful lot of normal patients without pain have FAI on their MRIs! So when you have hip pain and a doctor diagnoses FAI based on an MRI, is the FAI causing your hip pain or is it just a coincidence? Should we be treating something with an invasive surgery if that problem is really common in patients without pain and arthritis?
My recommendation? Clearly from the above, the Hip FAI Surgery success rate is not what you would think. Research a bit before you get hip arthroscopy surgery! Also make sure you check out all the alternatives!