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Home , Hip arthroscopy, Hip replacement, Hip resurfacing

Hip Impingement and . , Resurfacing, or Replacement: Is it Time for ?

Bryan Whitfield, MD [email protected] Hip Operations • Background of hip diagnoses • Treatment of hip pathology • Surgery candidates • Time for surgery? • Cases Intra-articular hip - diagnoses • FAI (femoroacetabular impingement) / acetabular labrum tear • Neck of the and rim of the socket run into each other • Tear the labrum. • Articular damage possible • Labrum: fluid management, stability, and seal of the

• Osteoarthritis • Socket and ball both coated in a layer of cartilage • is the wearing away, loss of or damage to the cartilage coating (articular cartilage) Intra-articular - diagnoses • FAI (femoroacetabular impingement) / acetabular labrum tear • Neck of the femur and rim of the socket run into each other • Tear the labrum. • Articular cartilage damage possible • Labrum: fluid management, stability, and seal of the joint

• Osteoarthritis • Socket and ball both coated in a layer of cartilage • Arthritis is the wearing away, loss of or damage to the cartilage coating (articular cartilage) Intra-articular hip pain - diagnoses • FAI (femoroacetabular impingement) / acetabular labrum tear • Neck of the femur and rim of the socket run into each other • Tear the labrum. • Articular cartilage damage possible • Labrum: fluid management, stability, and seal of the joint

• Osteoarthritis • Socket and ball both coated in a layer of cartilage • Arthritis is the wearing away, loss of or damage to the cartilage coating (articular cartilage) Intra-articular hip pain - presentation • Groin (sometimes side, buttock, or less often “hip”) • “C-sign” • Worse with sitting for a while then standing • Sore for 1-2 days after activity • Difficulty with donning or doffing shoes • Impact and cutting activities difficult Intra-articular hip pain – physical exam • Impingement sign • Decreased range of motion • Pain not recreated by examination of spine or other places Intra-articular hip pain – imaging • X-rays • Joint space • Cam lesion • Pincer lesion • MRI • If arthritis severe, unnecessary • helps diagnose labrum tear • Cartilage damage/absence • changes: cysts, edema Intra-articular hip pain – treatment • Medications • Rest • Activity modification • PT • Benign neglect (living with it) • Injections • Cortisone • Biologics • Surgery Intra-articular hip pain – SURGERY?! • Goals • Severity • Limitations • Are you living your own life or your hip’s life? • It is easier to fix your hip than your heart and your mind Intra-articular hip pain – SURGERY! • Scope • ≤ mild OA • Replace with resurfacing • Moderate to Severe OA • Age < 60 • Activity demands beyond limitations of replacement • Appropriate bone density • Males preferred (metal on metal reaction) • Replace with replacement • Severe OA • 60+ • No impact, cutting, running, jumping • AVN Intra-articular hip pain – SURGERY! •Scope •≤ mild OA • Replace with resurfacing • Moderate to Severe OA • Age < 60 • Activity demands beyond limitations of replacement • Appropriate bone density • Males preferred (metal on metal reaction) • Replace with replacement • Severe OA • 60+ • No impact, cutting, running, jumping • AVN Intra-articular hip pain – SURGERY! • Scope • ≤ mild OA • Replace with resurfacing • Moderate to Severe OA • Age < 60 • Activity demands beyond limitations of replacement • Appropriate bone density • Males preferred (metal on metal reaction) • Replace with replacement • Severe OA • 60+ • No impact, cutting, running, jumping • AVN Intra-articular hip pain – SURGERY! • Scope • ≤ mild OA • Replace with resurfacing • Moderate to Severe OA • Age < 60 • Activity demands beyond limitations of replacement • Appropriate bone density • Males preferred (metal on metal reaction) •Replace with replacement •Severe OA •60+ •No impact, cutting, running, jumping •AVN Time for Surgery?

• If scope is an option – sometimes treating earlier leads to better results (6 months to 1 year is ideal) • OA / articular cartilage damage • Outcomes • Secondary pain from biomechanical compensation

• If replacement/resurfacing is the consideration – put off as long as possible • Younger, more active patients will likely wear out their replacement faster Time for surgery? Case 1 • 43 y/o male • Avid tennis player • Hip pain x 3 years – Injured while hitting a backhand • Cortisone injection x 2 – Just a few days of relief Case 1

• MRI shows some mild narrowing of the cartilage and an acetabular labral tear with morphology consistent with both cam and pincer. The cysts in the are just on the margin consistent with impingement and not osteoarthritis. Hip Arthroscopy • Procedures performed – Femoroplasty – Acetabuloplasty – Acetabular labral tear repair – Microfracture of the right acetabulum Hip Arthroscopy

• 1 year postop: Back to full activities • Continues to do PT for hip and back – Works with tennis-specific PT • Very pleased with results Time for surgery? Case 2 • 63 y/o male • Insidious onset, exacerbated with tennis • Buttock pain with serving • Despite • • Cortisone injection (intra- articular) • NSAIDS Case 2

MRI 1.Severe osteoarthritis with multiple loose bodies 2.Diffuse labral tear with maceration 3.Tendinosis and partial-thickness tear of hamstring and glute tendons Case 2

Underwent left Hip Resurfacing

Andy Murray (31 years old): Hip Arthroscopy -> Resurfacing

Bob Bryan (40 years old): Hip Resurfacing

emoryhealthcare.org/sports Thank you • Bryan Whitfield, MD • Emory Sports Medicine specialist • Hip arthroscopy • • [email protected]

• George Guild, MD • Emory specialist (resurfacing)

emoryhealthcare.org/sports