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Hip Preserving Surgery

What is hip preserving surgery?

Most patients under the age of 60 who have hip arthritis have an underlying cause to explain why their hip has become arthritic.

The most common causes for hip arthritis are trauma, avascular necrosis, hip dysplasia (abnormally developed hip), slipped upper femoral epiphysis (growth plate injury around puberty), Perthe’s disease (avascular necrosis of the femoral head), and infection.

Hip preserving surgery is any procedure, other than joint replacement, which addresses the symptoms that the patient has as a result of an abnormal hip joint.

The most commonly hip preserving surgeries are osteotomies around the hip joint such as peri-acetabular osteotomy and or proximal femoral osteotomy (bony procedures to realign either the socket or femur bone), open hip debridement and hip arthroscopy.

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What is open hip debridement?

A recent development is the identification of a particular structural hip “abnormality” which predisposes a person to getting an osteo-arthritic hip at an earlier age than one would expect.

 

CAM impingement
An X-Ray showing the metaphyseal “bump” which may cause osteoarthritis by CAM impingement.

 

A slight abnormality in the growth plate during development of the femoral head may lead to an irregularity on the femoral-neck junction. This irregularity may result in a process known as CAM impingement or pincer impingement. As result of this process damage can occur to the acetabular labrum and the articular cartilage which may ultimately lead to an arthritic hip joint.

 

CAM impingement Pincer impingement
CAM impingement Pincer impingement

 

Techniques have been developed where the bony abnormality is removed and the labrum is re-attached and so theoretically prevents the onset of arthritis prematurely. In order to do this an open hip dislocation has to be carried out, however techniques are now being developed which allow some of these procedues to be done arthroscopically.

 

Metaphyseal Bump
Using a jig as a guide the “aspherical” portion of the femoral head and neck is removed at surgery.

 

Publication on open hip dislocation

Following hip preserving surgery a patient might still require a hip replacement but hopefully at a much later stage which may ultimately reduce the need for revision hip surgery.

Information on femora-acetabular impingement

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What is hip arthroscopy?

Hip arthroscopy is a procedure by which an “arthroscope” is passed into the hip joint. This allows the hip joint to be assessed and in certain cases the underlying hip problem can be addressed and treated.

Arthroscopy of the hip is much more involved and technically demanding than, for example, a knee arthroscopy. The hip joint is surrounded by many more tissue structures than the knee joint. Also because the joint is much more congruent a space has to be created for the arthroscope to gain access to the joint. This is done by applying traction to the leg. This distracts the joint and creates the space needed to carry out the arthroscopy.

 

Needle insertion Trocar insertion Labral Tear
During hip arthroscopy a needle is used to place fluid into the hip joint. With traction on the patient’s leg the hip joint is opened up so that the arthroscope can be placed in the joint. This intra-operative view shows a tear of the anterior labrum of the hip joint.

 

Information on hip arthroscopy

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What is trochanteric bursitis?

Trochanteric bursitis is inflammation of a fluid filled sack which separates musculo-tendinous structures from the greater trochanter (hip bone) of the hip.

 

Trochanteric Bursitis
Position of trochanteric bursa.

 

The main symptoms are pain overlying the hip bone sometimes radiating towards the knee during activity but especially when lying on the effected side at night.

Treatment may consist of the use of anti-inflammatories, physiotherapy, an injection with steroid and local anaesthetic, and rarely, in certain resistant cases, surgery may be indicated.

Information on trochanteric bursitis

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What is a snapping hip?

Clicking and snapping of the hip are common symptoms. As a rule of thumb, if they are painless than usually the underlying cause in not worrisome.

The most common cause is a tendon which rubs over a bony prominence around the hip joint.

The majority of treatments are non-surgical and some cases may require image guided injections around the hip joint.

Information on clicking hip

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