All diagnosis of a hip injury begins with taking a good medical history from the patient – identifying the specifics of the location, duration, and intensity of the pain, as well as, what makes it better or worse. We also perform a thorough physical examination to evaluate range of motion, strength, and stability. Finally, we add imaging studies, such as X-rays and MRI to assist with making the diagnosis. For hip problems, it is sometimes necessary to obtain a CT scan to evaluate the bones of the hip, and/or an MR arthrogram, a study where dye is injected into the hip joint, to provide additional information.
Hip injuries can show up in any sport, for example, Chase Utley and Alex Rodriguez in Major League Baseball. The most common sports for hip injuries, however, include ice hockey, soccer, gymnastics, and martial arts. The most common injuries seen in these sports include “snapping” hip, hip labral tears, adductor strains, and apophyseal injuries.
The treatment for all hip injuries is based on the diagnosis. Most hip problems can be treated without surgery by using a combination of physical therapy, strengthening exercises, stretching and rest.
Arthroscopy (surgery performed through small incisions using a pencil-sized camera for visualization) is useful for dealing with problems that are inside the hip joint. These include hip labral tears, hip impingement (femoracetabular impingement or FAI), loose bodies, or synovitis (inflammation in the lining of the hip joint). If a patient’s pain is the result of a problem outside the hip joint, it would not be treated arthroscopically.
As mentioned above, a patient first must have pathology in the hip joint to be considered for hip arthroscopy. Once that has been established, patients typically break down into two age groups. Most patients with labral tears are younger (less than 25) and more athletic while an older group of patients (45-50 years old) will likely be treated for impingement, synovitis, or loose bodies.
Very early hip arthritis may be able to be treated with arthroscopy, but by the time arthritis is severe enough to be noticed on an X-ray, it is too late for arthroscopy to help. Most patients with hip arthritis are treated with activity modification, weight loss and medications. Some patients with advanced hip arthritis will elect to undergo hip replacement surgery.