POSTED: WEDNESDAY, JULY 9, 2014
We've all heard of ACL and Tommy John surgeries. But, have you heard of “hip scope,” the newest surgery in sports? Chase Utley, Alex Rodriguez, Tim Thomas, Osi Umenyiora, Ed Reed: these are just a few of the big time athletes who have undergone hip arthroscopy. So, what is a hip scope? What does it fix? And how are athletes recovering from it?
Hip scope is short for hip arthroscopy and it describes the way the surgery is performed and not actually what is done. Hip arthroscopy is a newer technique and has advanced significantly over the last 5-10 years. With hip arthroscopy, the surgeon makes small portals or holes and uses a camera and surgical tools instead of making a large open incision.
There are numerous procedures that can be done through the scope. The most common are femoral acetabular impingement (FAI) decompression and labral debridement/repair. FAI decompression involves shaving down bone where the neck of the ball (femoral neck) pinches on the socket (acetabulum). Bone can either be shaved down on the femoral neck, the acetabulum, or both. For a torn labrum, it can either be trimmed or repaired with sutures depending on the location of the tear and the quality of the tissue. Other procedures that can be done arthroscopically are synovectomy, removal of loose bodies, articular cartilage procedures, capsular release (loosening) or plication (tightening), psoas tendon release, IT band release, and repair of a hip rotator cuff tear.
In young, athletic patients we can expect a full return to activity and sports after the surgery. The time frame to return to full athletic participation is about 4-6 months. A 2011 American Journal of Sports Medicine study by Kelly et al looked at outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. In that group, 78 percent of athletes were able to return to play by one year and 73 percent of athletes were able to play at a two-year follow-up. Another 2011 American Journal of Sports Medicine study by Byrd et al looked at arthroscopic management of femoroacetabular impingement in athletes. In Byrd’s study, 95 percent of professional athletes and 85 percent of intercollegiate athletes were able to return to their previous level of competition. These articles show that in younger, high level athletes the outcomes are very successful. What they don’t show are the results at 5 and 10 years. In patients over 35, the outcomes aren’t as good, as the problem is usually longer standing and has likely started to show some signs of early cartilage damage (i.e. arthritis). A 2014 study in Knee Surgery, Sports Traumatology, Arthroscopy by Krych et al looked at isolated arthroscopic labral debridement for hip labral tears in patients between the ages of 32 and 60. Of these patients, 45 percent had combined poor results when strictly defining failure as repeat surgery or abnormal hip rating. Untreated FAI and concomitant chondroplasty were risk factors for inferior outcome. As with most orthopedic problems, patients under 35 show good results, while patients over 35 show less favorable outcomes.
Postoperative rehabilitation is a very important factor in the outcome of hip arthroscopy. The key is to correct any underlying dysfunction that may have led to the surgery (ie flexibility, strength, alignment, etc). What we typically see with hip problems is a loss of internal rotation range of motion, gluteus medius weakness, and core weakness. It is important to see an athletic trainer or physical therapist that specializes in hip rehabilitation as the postoperative rehabilitation guidelines are still being developed and those without experience may do more harm than good.
So the next time you see an athlete on the IR or DL following a hip scope, you might be wondering (as I always do) what they really had done. We know that following this procedure, the athlete should be back and playing at some point, but the question is when. Your fantasy draft may depend on it.