Did the Whole Concept of Hip Arthroscopy for Impingement Just Get Wrecked by a Single Research Paper?
A new Hip Impingement Arthroscopy Research Paper calls into question the whole concept behind the surgery…
We’ve been critics of what we call, “Hip Arthroscopy Mania”. Basically, most commonly, a bone spur is detected on the outside (lateral) portion of the socket (acetabulum) of the ball and socket joint of the hip. The story goes that this bone spur can impinge on the ball (femoral head) and hurt the cartilage, leading to arthritis. This has lead to a new surgical approach this past decade where the bone spur is taken off surgically, hopefully protecting the cartilage. All of this was based on some studies that showed that patients with these bone spurs had more arthritis. What we didn’t know was what came first, the chicken or the egg? Meaning did the bone spur form because of the arthritis or was the bone spur the cause of the arthritis. The only way to answer this was not to do more snapshot studies of whether people with arthritis have the bone spurs, but to follow people with mild arthritis while they developed the spurs.
An innovative group of physicians just did this in Norway and what they found isn’t good for concept of whacking off these hip bone spurs through hip arthroscopy. They basically found that the bone spurs formed because of the arthritis and may be protective of the arthritis becoming more severe. This fits with what I’ve discussed previously about bone spurs. These spurs are good and they protect the joint, so taking them off is likely a bad idea.
The upshot? IMHO Hip arthroscopy mania is just that, lots of surgery, much of which isn’t helping patients nor well thought out. I guess the only good news for hip arthroscopy surgeons out of this recent Hip Impingement Arthroscopy Research Paper is that patients who have a short socket (hip dysplasia) do develop arthritis that seems to be from the small socket. What we don’t know yet, with high levels of evidence, is if reshaping the socket to be bigger saves this type of joint from arthritis.