Sports docs’ weekly blitz: Hip labral tears and the impact of arthroscopy

Over the last 10 years or so, hip injuries in athletes has gained greater attention than they had previously. One reason for that is the development of safe ways to work on the hip with arthroscopic means.

We can now work on cartilage problems and bone lesions around the hip through 2 or 3 portal sites.  Previous to the development of safe ways to perform arthroscopic surgery in the hip, hip lesions required a large, open incision and often the hip had to be dislocated to work on the intra-articular structures. Being able to do such procedures through 2 or 3 portal sites is one of the biggest advances in all of orthopedics in the last few decades.

Furthermore, if we can treat bone lesions that lead to labral tears before arthritis sets in, we may be able to delay or even prevent hip arthritis. For this reason alone, hip arthroscopy has been a huge breakthrough in orthopedics. Attached you will find a video of a hip scope I performed when I was at the Hospital for Special Surgery in New York.

Unfortunately, not all patients with labral tears in the hip are good candidates for hip arthroscopy.  Once arthritis has started to set in, the degenerative changes are often irreversible. Furthermore, in some instances, treating bone spurs in the setting of arthritis may actually contribute to the acceleration of arthritis. This can happen because increasing the range of motion of the hip by removing the bone spurs also increases the shear forces the degenerative articular cartilage is exposed to, thereby furthering the damage. 

I am very selective on who I indicate for hip arthroscopy. The most predictable patients to benefit from hip arthroscopy are typically less than 35 years old or so. That being said, I always evaluate hip pain on a patient by patient basis. Some patients who are not candidates for hip arthroscopy may benefit from injections, much like we give for chronic shoulder and knee problems.

If you are interested in learning more about hip arthroscopy for athletes, please visit my website at www.BryanWarmeMD.com, where you will find multimedia and also an hour-long presentation I did on the subject. Thanks for reading! Doc Warme.