Osteoarthritis of the hip is a condition in which the cartilage on the femoral head and/or acetabulum (cup portion of the hip joint) begins to wear out. As this progresses, the hip gets stiff and painful. Most patients notice pain in the groin, buttock or thigh. People begin having difficulty doing activities such as tying shoes. Treatment for arthritis of the hip can vary from anti-inflammatory medications and physical therapy to hip replacement or hip resurfacing surgery.
Some people with very early arthritis of the hip, or anatomy that may predispose them to developing arthritis, may be candidates for arthroscopic hip surgery. This surgery may be able to prevent the progression of arthritis. Arthroscopic hip surgery is still early in its development. Dr. Mayman is part of the “Hip Preservation Center” at the Hospital for Special Surgery where he is one of a team of surgeons researching new techniques that may help prevent or delay the need for hip replacement surgery
Hip Labral Tear
The hip joint is surrounded by a ring of cartilage called the labrum. This cartilage deepens the hip joint allowing the forces in the joint to be spread out over a larger surface area. The labrum cartilage also forms a suction fit of the hip joint. It is possible to tear the labrum cartilage. This can happen during a traumatic event to the hip joint, but can also happen with minimal trauma. MRI scans can show tears in the labrum.
Typically patients with labral tears complain of pain in the groin. Most patients have difficulty with twisting or pivoting activities.
Patients with labral tears but normal articular cartilage can be treated with physical therapy, anti-inflammatory medications, cortisone injections or arthroscopic surgery.
A condition called femoroacetabular impingement is a condition that we have been learning more about in recent years. This is a condition where the anatomy of the femur or acetabulum is slightly abnormal causing the neck of the femur to impinge on the edge of the acetabulum when the hip is flexed and rotated. This can cause labral tears and delamination of the articular cartilage of the acetabulum. This appears to be a precursor to hip arthritis in a certain percentage of patients.Most patients with femoroacetabular impingement complain of groin pain with flexion and rotation of the hip. Often these patients note that they have always had poor flexibility of the hip. If this condition is discovered before the patient has significant arthritis of the hip joint it can be treated with arthroscopic surgery. We believe that early treatment of this condition with removal of the impinging bone may decrease the incidence of hip arthritis in this patient population.
Painful or Failed Hip Replacements
There are many reasons that hip replacements can fail. Treatment of patients with painful or failed hip replacements must be individualized. Patients will often require radiographic tests such as x-rays, bone scans, CT scans or MRI’s in order to determine the cause of failure and the most appropriate plan to correct the issue. Patients will often also require blood tests and an aspiration of the joint in order to rule out an infection in the joint. Dr. Mayman will work with you to come up with the most appropriate treatment plan for your particular case.