If one watches any sports highlight show, "ACL tears" and "Tommy John procedures" are commonly referenced and understood by the lay public. Although the shoulder, elbow, knee and ankle are perceived as "sports joints" that are susceptible to athletic injuries, the hip is generally not considered in the same vain. "The hip is usually considered a "geriatric joint" since it commonly breaks or fractures in older patients and is quite susceptible to arthritis," says Dr. Anil Ranawat of the Sports Medicine Service at the Hospital for Special Surgery in Manhattan. The hip, however, is a commonly injured athletic joint! Common hip injuries include labral, capsule or muscle tears, cartilage injuries, dislocations, and loose bodies. Chronic conditions such as femoro-acetabular impingement (FAI) can also cause hip pain in athletes.
FAI is a disorder which has been popularized by Swiss surgeons taking care of elite athletes, skiers, military recruits and weekend warriors. The hip is a ball and socket joint, and in this disorder, the ball (or femur) pathologically impinges on the cup (or acetabulum). "The result of this impingement can be a labral tear, cartilage injury or even early arthritis. The most important part of treating FAI properly is early diagnosis, since these patients are often misdiagnosed with an inguinal hernia, sports hernia or other complaints," adds Dr. Ranawat. Although MRI and CT scans are important diagnostic images, well performed x-rays or radiographs are even more important. Recently, many theories have been advanced on how best to treat this condition. Potential treatment options include: physical therapy, cortisone injections, or, ultimately, surgery. "Arthroscopic surgery is usually the surgery of choice, but in rare cases, an open incision may be necessary," says Ranawat. Although either technique is effective, patients often prefer the arthroscopic technique since there is less tissue trauma and smaller incisions. The key, however, is not the size of the incision but how well the procedure is performed.
Dr. Ranawat contends that the most exciting aspect of this field is that patients do quite well after these procedures. They return to high levels of function; and are, most importantly, pain-free and oftentimes have increased range of motion. In addition, most of these procedures are outpatient day procedures, i.e. the patient goes home the same day. We also know that "younger, more active patients seem to do better than patients with more advanced disease". Therefore, early diagnosis and intervention is key. Finally, although we are not certain yet, we hope the proper management of impingement will one day prevent or delay arthritis. As baby boomers continue to stay active in sports, our treatment modalities must also adjust to keep up with them and keep them going for decades to come. Arthroscopic impingement surgery is on the cutting edge of new procedures that will help patients, doctors and therapists alike make the hip more understood!
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For more information about sports medicine, visit the Joe DiMaggio Sports Medicine Center.
Mission statement: Manhattan's Joe DiMaggio Sports Medicine Center is devoted to rendering the very best non-surgical foot and ankle care, specializing in effective, non-intrusive methods as a primary objective. At the same time, the Center is affiliated with the world renowned Hospital for Special Surgery (HSS), affording traditional surgical and other options. The HSS has been recently rated the Number One hospital in the country for orthopedics by the US News and World Report. The Center also offers the expertise of orthopedic surgical and non-surgical clinicians in all areas of care.
The Center is named after American sports icon Joe DiMaggio, whose heel spur disability remains one of the most well-known sports injuries in history.