FAQ Category: Hip

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.

Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment.

The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence.

Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.

One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.

If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high.

For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.

The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.

First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study.

Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice for you.

Femoroacetabular impingement (FAI) of the hip is a condition in which some portion of the soft tissue around the hip socket is getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. Surgical treatment is often recommended, especially when conservative (nonoperative) care does not reduce the painful symptoms or improve function.

Hip replacement is much more invasive and obviously does not preserve the bone and joint like the reshaping procedure you have had done. But studies show that in about one-third of the patients, attempts to surgically repair the problem are unsuccessful. Like you, those patients end up converting to a total hip arthroplasty (replacement).

There aren’t a lot of large studies to help identify the most optimal treatment for each patient with femoroacetabular impingement. Those who are the least likely to benefit from a repair procedure have severe joint damage and advanced osteoarthritis. But because just as many patients with these findings have good results with the repair/reshaping surgery, we don’t know yet who should go straight to the replacement procedure and who would benefit from the intermediate step of surgical repair.

Based on what we do know, your treatment was according to the standard protocol. For whatever reason(s), you fell into the 30 per cent who don’t have a positive outcome. Fortunately, there is a “rescue” operation available in the joint replacement procedure.

Not necessarily though many individuals with femoroacetabular impingement (FAI) do indeed eventually develop degenerative changes that lead to arthritis. This is most likely to happen in cases of untreated FAI.

Let’s define femoroacetabular impingement and talk about how it can lead to osteoarthritis of the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed.

Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The cam-type of impingement is the most likely to set up conditions ripe for joint wear and tear. This type occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a tilt or pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.

The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface. This abnormal contact between the femur and acetabulum is the leading cause of labral tears and degenerative hip arthritis.

Treatment is advised when impingement is painful, limits function, and/or X-rays show potential for joint changes. You may be able to follow a conservative path by modifying activities and carrying out a program of strengthening and stretching exercises. In some cases, surgery is indicated to correct the problem.

No one knows for sure who will develop arthritis. Studies are underway to determine how common is the problem and what factors might increase the likelihood of developing arthritis. Your orthopedic surgeon will follow your case and advise you if and when treatment (and what treatment) is appropriate.

Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis.

In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.

One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.

Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.

In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.

There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage).

When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).

What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing problems.

Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are two different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The first is called cam-type impingement. This occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a pistol grip deformity. The femoral head isn’t round enough on one side (and it’s too round on the other side) to move properly inside the socket.

The result is a shearing force on the labrum and the articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the hip socket. The articular cartilage is the protective covering over the hip joint surface.

Sometimes cam-type impingement occurs as a result of some other hip problem (e.g., Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or SCFE). But most of the time, it occurs by itself and is the main problem. Men are affected by cam-type impingement more often than women.

Although we know a lot about the causes of this condition, what to do about it remains in question. Can it be prevented is the first question. Should we even try to prevent it is the next question.

Some people have abnormally shaped hips but don’t ever develop symptoms. It has been suggested that we need to figure out who is at risk for pain and other problems from FAI before launching into a prevention program for everyone.

On the other hand, if some easy screening tests were done to find those individuals who are at risk, then perhaps a careful wait-and-watch program would be helpful. Or maybe some simple changes in activity would be all that is needed. Preventing substantial changes in the hip and the need for surgery would be a worthy goal.

Conservative (nonoperative) care really requires early recognition. So, it’s a “catch-22” kind of situation. There’s no evidence that screening and prevention help but without catching the problem early, conservative care quickly gets replaced by a more invasive approach with surgery.

Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The postoperative recovery period may include a specific rehabilitation program. It depends on what the surgeon did. A simple debridement (removing loose or frayed cartilage) requires less postoperative caution than reshaping and repair procedure. The concern is for regaining hip motion, maintaining joint stability, and preventing complications.

The more complex procedures will require the athlete to keep weight off the hip and avoid twisting motions for at least a month. This can be accomplished by using crutches. The athlete is gradually allowed to return to light activities at first. Avoiding twisting motions is enforced for a full three months. It will be six months or more before the athlete is allowed to return to full sports participation.

Studies done so far show that up to 90 per cent of athletes with femoroacetabular impingement repaired surgically get back to their previous level of sports participation. That includes college athletes, as well as professional and recreational athletes. With longer follow-up, other studies have shown that this number dwindles over time.

There is some evidence that arthroscopic surgery yields better results than open surgery. More study is needed to confirm this is true and perhaps identify which athletes would do better with arthroscopic versus open surgery.

Your surgeon will be able to give you a better idea what to expect for short-term and long-term results after he or she has a chance to perform the surgery. Follow the post-operative recommendations carefully but expect a full recovery and a chance to get back on the ice.

Osteonecrosis means “bone death”. Loss of blood supply, bone death, and collapse can occur over a period of months to years. The femoral head is the round ball at the top of the thighbone that fits into the hip socket. Osteonecrosis can be caused by steroid use, alcohol, trauma, and blood-clotting problems like Sickle Cell Disease. In some cases, no cause can be found.

Many people who have been diagnosed with osteonecrosis of the femoral head already have the same problem in the other hip. They just don’t know it because the disease can be “silent” or asymptomatic. In other words, there’s no pain. If it wasn’t for the telltale signs on X-ray, the affected individual wouldn’t even know there was a problem.

The majority of people who have femoral osteonecrosis in one hip will go on to develop the same problem in the other hip. But this isn’t always the case and even if it does happen, treatment may not be needed.

So how does a person decide what to do? The first goal in treating symptomatic (painful, limiting) osteonecrosis of the femoral head is to save the bone. The second goal is to keep function while relieving pain. Your surgeon will be able to advise you as to the best course of action for you.

That still doesn’t answer the question about what to do for that asymptomatic hip. Is treatment needed at all? What’s the natural history (i.e., what happens over time if it is NOT treated)?

In a recent systematic review of the literature, surgeons who conducted the study concluded that large lesions along the outer two-thirds of the femoral head are in the greatest danger of further destruction and collapse. Those should be treated right away. Small-to-medium lesions can be watched carefully and treated conservatively at first.

Any sign of progression of disease should be addressed immediately. Anyone with known risk factors (Sickle cell disease, prolonged use of steroids, alcohol abuse) should be watched closely as well.

Some surgeons advocate what is referred to as careful neglect. This is a watch-wait-and-see approach. But there are just as many orthopedic surgeons who say head it off at the pass. In other words, treat it early and prevent the problem from getting much worse.

The voice of reason and experience comes through loud and clear on this one: study patients who have this problem and see if there are any predictive factors of disease progression. Those patients who have significant risk factors for progression of disease without treatment should be teated early in the course of their disease development.

It is possible that the question of how (and when) it’s best to treat asymptomatic (no pain, no symptoms) osteonecrosis of the femoral head has already been answered but lies buried in the medical literature. That’s why a group of surgeons from the Center for Joint Preservation and Replacement at Sinai Hospital in Baltimore, Maryland reviewed all of the articles they could find published on this topic up to the middle of 2008. This type of study is called a systematic review.

Information collected from the studies that were high enough quality to be part of the review included patient age, how long they were followed, location and size of the bone lesion, and use of certain medications (e.g., steroids) or excessive alcohol. They also looked at personal medical history of lupus, sickle cell disease, kidney disease, kidney transplantation, and human immunodeficiency virus (HIV).

By combining all the hips studied into one group, they found that 394 of the total 664 hips developed symptoms and eventual collapse. That’s a percentage rate of about 59 per cent (more than half, almost two-thirds). The destruction took place over a period of time from as little as two months and as long as 20 years.

There were some telltale factors to help predict who might go on to a symptomatic phase. The size of the lesion was the main risk factor. The larger the lesion at the time of diagnosis, the more likely destruction and collapse were to occur in time. Patients with sickle cell disease were also at great risk of disease progresion. Patients with lupus were much less likely to progress to collapse unless they were taking steroids over a long period of time.

The authors concluded that based on the systematic review there is enough evidence to support a more aggressive approach to treating asymptomatic hip osteonecrosis. Large lesions are likely to get worse, so don’t wait. A wait-and-see approach may be okay for smaller areas of bone death but the patient should be followed closely. Any sign of progression should be addressed right away.

Femoroacetabular impingement occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The diagnosis begins with a patient interview and history. Then comes a physical exam. The physician looks at pelvic and hip motion and palpates muscles and tendons for areas of tenderness.

There may be a telltale snapping of the iliopsoas tendon as the patient moves the leg from one position to another (flexion to extension, external rotation to internal rotation). Several other tests can be done to identify what’s going on.

As is often the case, one problem can lead to others. With femoroacetabular impingement, hip bursitis can develop. The gluteal (buttock) muscles may be extra tender or sore from trying to compensate and correct the problem.

The clinical exam is followed up by imaging studies including X-rays, MRIs, and CT scans. X-rays show the presence of any extra bone build up as well as the position and alignment of the bones and joint. Using different X-ray views, the radiologist and orthopedic surgeon can see the shape of the femoral head and look for any asymmetries (i.e., where the head is no longer an even round shape).

MRIs can show any damage to the labrum but not necessarily to the surface of the hip joint. The presence of edema (swelling) under the bone may show up and requires further evaluation to decide if it is from femoroacetabular impingement or some other cause (e.g., cyst, tumor, stress fracture). Using MRI with a dye injected into the joint (called magnetic resonance arthrography or MRA) provides greater detail of the joint surface and may be needed.

CT scans help show the exact shape of the bone and reveal any abnormalities in the bone structure. CT scans might be the most helpful when arthroscopic surgery is planned. It gives the surgeon a better idea of what needs to be done to reshape the bone. If the procedure is going to be done with an open incision, then the CT scan isn’t necessary. The surgeon will see everything once the area is opened up.

It might depend on the cause of the problem. If you have a femoroacetabular impingement, then early osteoarthritis is possible, even probable. Just the slightest change in the morphology (shape and structure) of the hip joint can cause problems like this.

Femoroacetabular impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

The first type of femoroacetabular impingement (FAI) is called pincer impingement. This type occurs when the rim of the acetabulum (hip socket) sticks out farther than normal.

There are several causes of this problem. There can be an overgrowth of cartilage forming the rim or even extra bone that forms in the area. Sometimes the hip socket is tilted backward slightly. In either case, every time the athlete flexes the hip, the rim that’s sticking out too far pinches the labrum against the neck of the femur. The labrum is a fibrous rim of cartilage around the socket to help give it some depth. It is a normal part of the hip biology.

The second type of femoroacetabular impingement is called CAM impingement. Normally, the head of the femur is a smooth, round shape. It is even all around so it can rotate inside the socket evenly. But any change in the shape can cause it to hit one point of the socket more than the others as the head of the femur moves inside the socket.

The asymmetrical rotation of the pistol-shaped femoral head is called the cam effect. Anytime something repeatedly rubs against something unevenly, there is uneven wear, tear, and damage. In this case, when the hip is flexed or bent, the unevenly shaped femoral head doesn’t glide over the labrum as it should. Instead, it bumps up against the edge of the cartilage. Over time, the labrum gets worn down to the bone.

And finally, the third type of femoroacetabular impingement is a combination of the two just described (pincer and cam). Cam impingement is more common in males and brings on symptoms earlier than the pincer type. The combination of both types together causes problems sooner than if only one type was present.

The best thing to do is see an orthopedic surgeon for an examination and diagnosis. It may be good to do this before any more time passes by. Early recognition and treatment of most hip disorders involving the soft tissue structures help prevent serious complications later.

Many seniors put off having a total hip replacement despite the pain and loss of function that the arthritic joint is causing. They are afraid that it will hurt even more after the surgery and take a long time to recover. At least right now, they can walk without a walker. After surgery, the thought of using a walker or cane is enough to keep them away.

Yet every year there are nearly one million adults who do have a total hip or total knee replacement. And that figure is expected to increase to four million in the next 20 years. So while some are hesitant, those who aren’t may experience an even faster recovery time thanks to the results of some recent studies.

Surgeons and physical therapists are working together to find the fastest way through surgery and rehab with the least amount of pain and disability. Sound like a tall order? Surprisingly, patients seem to adapt well and the results speak for themselves.

Patients in a rapid recovery program go directly home two days (sometimes three days) after surgery. Patients in a traditional treatment group are more likely to be discharged to a rehabilitation center around day 4 after surgery. If the traditionally treated patient goes home directly from the hospital, then a treatment program continues at home.

In a recent study at the Cleveland Clinic (Ohio), walking distance was twice as far in half the time for the rapid recovery group. That result alone brought smiles to the patients’ faces as they reported a much higher level of satisfaction compared with the traditional group. But there was another positive finding from that study. The rapid recovery group reported significantly less pain and less use of pain medication.

The goal of the rapid recovery program is to cut costs while still maintaining patient safety and excellent results. Decreasing the number of days patients are in the hospital while increasing their level of independent function by the time they are discharged is possible.

This type of multidisciplinary approach may be just what you need. With the support, guidance, and direction of your physician, nurses, and physical therapist, you may find your fears are put aside.

A recent study from the Cleveland Clinic in Ohio might be of interest to you. Surgeons from the Cleveland Clinic in Ohio divided a group of 103 total hip patients into two groups. One group (73 patients) had the traditional post-operative treatment after hip replacement. The second group (30 patients) tried a new rapid recovery program.

The rapid recovery program combined several factors to enhance recovery. First, the surgeon used incisions that don’t cut through the abductor muscles. The abductor muscles are along the inside of the thigh and help bring the legs together. Second, nurses supervised the use of pain medications. Pain management began in the operating room where patients received a special injection of numbing agents around the joint just operated on.

And third, the patients were seen right away by physical therapists on the multidisciplinary team. The traditional program allows patients to rest the first day after surgery. They get up and move much more slowly with the traditional approach compared with the rapid recovery program.

Getting up the day of surgery and walking small amounts frequently throughout the day is part of the rapid recovery program. Walking is followed up with an exercise program that is supervised by the therapist twice a day.

Surgeons around the country are trying different ways to speed up recovery and return to full function. This is just one example that seems to be working well. You may have to look around in your area to find a surgeon who is on board with a slightly different approach to thotal hip replacements. The traditional approach is tried and true but it may hold you back a bit.

The labrum is a horseshoe-shaped bit of fibrous cartilage lining the hip and shoulder sockets. It has multiple functions so maintaining a good, healthy labrum is important.

For example, the labrum increases the size of the joint surface and the joint socket. Another term for the hip socket is acetabulum. This increase allows for a more even distribution of load across the whole joint.

Another task the labrum carries out is to act like a suction cup creating negative pressure in the joint. The seal that forms holds the lubricating synovial fluid inside the joint. The net effect is that the labrum reduces joint friction, a protective feature against degeneration leading to arthritis. When combined together, the various functions of the labrum help maintain joint stability.

Surgery is usually the recommended course of action for a symptomatic labral tear. Patients often ask if the problem can correct itself with time and rest. The answer to that question is maybe. The labrum doesn’t have its own internal blood supply. Without a good blood supply, healing isn’t possible.

The labrum depends on the blood vessels in the acetabulum (hip socket) and surrounding soft tissues. Someof the tiny blood vessels from these others areas reach the labrum to supply oxygen and healing nutrients.

Some areas of the acetabulum have more blood than others. So depending on the location of the labral tear, self-healing might be possible. In other words, healing may occur when the tear is closest to the best blood supply.

Based on imaging studies available, your surgeon will be able to answer this question best. The location of the tear and the size of the tear are the two main factors in the decision. Your surgeon will also evaluate your level of fitness and activity as important guides in the decision-making process.

Don’t be afraid to call your surgeon back and ask these specific questions. He or she may not know what level of activity you would like to engage in. Hip joint resurfacing is a fairly new procedure. In fact, it’s new enough that standard guidelines for post-operative activity based on sound evidence just aren’t available yet.

Each surgeon advises his or her patients based on what we do know combined with your own individual patient factors (e.g., condition of your bones, your age, your general health). There is general agreement that patients should avoid putting full weight on the leg during the first weeks after surgery.

Partial-weight bearing is usually advised for the first week with crutches or two canes. The crutches and canes can be replaced in the second week with a single cane. The cane can be eliminated after that according to how comfortable the patient is with walking unaided.

Following a six-week program of rehab exercises, patients are allowed to gradually increase their activity level (frequency, intensity, and duration) as tolerated. That means you go at your own pace and as your surgeon put it so well, “gradually get back into the swing of things.”

If it’s any help, a group of German surgeons followed 152 patients for two years after their hip resurfacing procedure to see what kind of activity level they achieved. They found that adults under age 55 were more likely to stay active and at a higher level of activity. Men were more active before surgery but the participation level between men and women evened out after surgery.

Only a small percentage (two per cent) of the people in the study gave up their sports involvement. Tennis and skiing were the two activities patients gave up most often. The number of patients involved in high-level sports definitely decreased after the hip resurfacing procedure. Some of the changes made were based on their physician’s recommendation. Some changes in behavior was attributed to their own fears and uncertainties.

You are not alone though your situation is certainly unique. The problem of squeaking hips after joint replacement has increased in the last 10 years with the increased use of hard-on-hard bearings.

What do we mean by hard-on-hard bearings? The two main parts of the hip that are replaced include the round head at the top of the femur (thigh bone) and the cup-shaped hip socket.

The materials used for these component parts can be ceramic-on-ceramic, metal-on-metal, or metal-on-polyethylene (plastic). Metal-on-metal and ceramic-on-ceramic are the hard-on-hard bearings. Ceramic-on-polyethylene and metal-on-polyethylene are considered hard-on-soft bearings.

It appears that there are three main factors involved and usually more than one reason for the squeaking. Patient factors such as body size and mass (larger), height (taller), and activity (hip flexion) may be part of the problem.

There’s not much a person can do about their height to change the squeaking. But they can be advised to avoid activities or movements that cause the squeaking. That’s a bit tricky for a priest who must genuflect (bend on one knee down and up) or kneel repeatedly.

Whenever possible, replace kneeling with bowing. When genuflecting is required, try using the other leg as the bending side. And if possible, find the range-of-motion that is squeak-free and stay within that range. This may mean you don’t go down as far when genuflecting.

Sometimes, it’s not the patient at all but rather the way the implant was placed in the hip. The wrong angle, a slight twist of the cup (socket) piece, or a little bit of both has been linked with squeaking.

But the most likely factor is the implant itself and in particular, the materials it is made of. The newer implants made of titanium alloy are more flexible and less stiff. This feature could increase the vibrational force that creates friction and squeaking. Other contributing factors include loss of fluid lubricating the hip, tiny particles of metal or other debris from the implant, or damage to the surface of the implant.

See your surgeon, if you are unable to find ways to avoid the squeaking. A simple revision surgery may be all that’s needed. Replacing the liner or altering soft tissue tension could make all the difference.

A high pitched sound that can be heard with hip movement after a hip replacement is not uncommon. The problem was first reported back in the 1950s. Some design changes were made and the problem seemed to correct itself.

Then ceramic-on-ceramic implants became popular again in the 1970s. The squeaking problem developed again. Sound studies were done and joint replacement engineers found that hard-on-hard implants (e.g., metal-on-metal or ceramic-on-ceramic) made the most noise.

The newer implants made of titanium alloy are more flexible and less stiff. This feature could increase the vibrational force that creates friction and squeaking. Other contributing factors include loss of fluid lubricating the hip, tiny particles of metal or other debris from the implant, or damage to the surface of the implant.

When surgeons remove squeaking hips, they often find a stripe along the implant where stress and friction have worn it down. Since squeaking occurs most often with hip flexion (bending, walking), the location of the stripe suggests edge-loading wear. Edge-loading refers to the upper/outer (superolateral) edge of the liner of the socket coming in contact with the upper (superior) surface of the femoral head.

Squeaking doesn’t develop until the patient has had the implant for quite a while (six months or more). The time delay is consistent with the stripe wear just described as well as the loss of lubricating fluid. Likewise, metal debris caused by impingement (one part of the implant is pinching against another) accumulates over time.

It’s probably time for you to make a follow-up appointment with your surgeon to find out what’s going on. Treatment usually begins with avoidance of all movements that make the hip squeak. But you may be a candidate for some simple revisions of the implant and/or hip.

The labrum is a thin but helpful extra layer of cartilage around the hip and shoulder joints. In the hip, it helps extend the edges of the joint socket to form a deeper cup for the round head of the femur (thigh bone). This helps keep the joint in the socket while still allowing a wide range of movements needed by the leg.

Damage to the labrum can result in painful symptoms. Sometimes there is a clicking sensation and the hip can even get locked up if the torn labrum gets caught between two structures of the hip. Loss of hip motion is the outcome of either of these symptoms.

There is a chance that the labrum can heal itself but most of the time, surgery to remove the ragged edges of the torn labrum is required. This procedure is called debridement. The surgeon shaves off the ragged edges of the labrum and smoothing the remaining edges.

A more extensive surgery called a partial labrectomy may be needed. This involves removing the unstable part of the labrum. Studies show that partial labrectomies have better outcomes when there isn’t damage to the underlying layer of cartilage attached to bone. The success rate drops from 90 per cent without chondral lesions down to 21 per cent for those patients with chondral defects.

A newer approach to labral tears is now in use: labral repair. During a labral repair, the surgeon uses stitches and surgical anchors to reattach the torn labrum. Results of labral repairs have not been published yet in English-language medical journals.

Most of the research that has been done has been published in European or Spanish-language journals. When valid and reliable tools are available, the results of debridement, partial labrectomy, and labral repair can be compared.

Your surgeon will probably go over the various surgical options available to you and recommend the one that will work the best for the type of injury and damage you have.

Hip Resurfacing is a new way to manage painful joint destruction at an age too young for a total hip replacement. Active adults thinking about having this procedure done (or like you have already had it done) want to know — how active can I be after recovery? Can I run? Play tennis? Join a soccer team? Go skiing?

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement.

Special powered instruments are used to shape the bone of the femoral head so that the new metal surface will fit snugly on top of the bone. The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. The patient must have enough healthy bone to support the cap. The hip
socket may remain unchanged but more often it is replaced with a thin metal cup (the acetabular component).

In theory, the level of physical and sports activity might cause the component parts to loosen or wear out. There is an additional fear of fracture or hip dislocation. But in reality, we really don’t know if these problems are likely or not.

Surgeons may caution patients to reduce their participation in high-level impact sports in favor of low-impact sports. Instead of playing tennis, soccer, or volleyball, they might be advised to stick with fitness and weight training or riding a bicycle. Some of the more active, athletic patients may think this is pretty boring and unacceptable.

They may be looking for solid evidence to prove these restrictions are necessary. There’s really no evidence to support one approach over another (i.e., inactivity versus activity). All the research on physical activity and exercise in general supports staying active as a way of maintaining good health.

Currently, there are no universal or standard guidelines for activity after hip resurfacing. Short-term reports focused on activity level show that patients are all over the map from reducing their activity level to resuming previous activity levels (including full sports participation).

Precautions are given at first to prevent complications like hip fracture or dislocation. There is always a risk of these things happening in older adults, especially anyone who is osteoporotic (has low bone mass density). Weight-bearing activities and exercise are actually ways to prevent osteoporosis.

You should be safe to engage in low-to-intermediate impact activities such as walking, bike riding, weight-training, or fitness exercise. High impact activities such as tennis, running, skiing, and other active sports may be okay, too. Check with your orthopedic surgeon first and make sure there are no specific reasons why you should avoid such activities.

Bone pain from osteoid osteomas usually occurs in young men between the ages of five and 24 (though it has been reported in older adults). Without knowing there’s a tumor present (and without a more dramatic presentation), it’s easy to think that the fellow is having growing pains.

But pain at night that wakes the person up from a sound sleep is a red flag for cancer. Then the picture of a young person with bone pain at night suddenly becomes more compelling.

Why does this type of pain develop? It turns out that cancer cells can signal the normal healthy tissue to form tiny blood vessels between the healthy tissue and the cancer. The process is called angiogenesis.

The net effect is to siphon off blood to the tumor. This creates a loss of blood supply to the surrounding healthy tissue, a condition called ischemia. Without oxygen, the body sets up a pain response. Since most of this happens at night when the body is in a semi-state of hybernation, the symptoms don’t occur during the day.

Osteoid osteoma is the most common of the benign tumors involving bones. Most of the time, osteoid osteomas affect males between the ages of 5 and 24. A benign tumor doesn’t spread or metastasize like a malignant tumor can. But that doesn’t mean it isn’t symptomatic. Depending on the location of the tumor, intense pain and weakness are common.

Surgery to remove the tumor may be necessary if the symptoms are severe enough or disabling in any way. The surgeon performs a procedure called an en bloc resection meaning that the entire tumor plus a thin edge of normal bone around the tumor are removed.

Numbness in the groin area may suggest injury to the pudendal nerve. this nerve passes through the hip and pelvis areas before dropping down to the genital or groin area. Most of the time, the symptoms of numbness don’t last. Usually within four to six weeks, the affected individual is back to normal. It’s one of the few complications of en bloc resection of osteoid osteomas in the hip area.

Be sure and let your son’s surgeon know of this persistent numbness and have the physician double-check to make sure there isn’t something else going on.