“Hip and Femoral Pain” Treatment

  There are many patients with “hip pain”, which is mostly a nagging pain around the hip joint. Due to the deep location of the hip joint, it is difficult to clearly locate the pain in this area; patients often feel pain and discomfort in the front of the hip joint, groin and buttocks, which are difficult to locate due to the deep location. The pain is sometimes accompanied by popping and interlocking sensations, and there may also be a reduction in mobility such as hip extension and rotation.  The causes of hip pain are many and vary greatly by age. Currently, for adult or adolescent hip pain, the clinical diagnosis is mostly focused on several aspects such as femoral head necrosis, synovitis, rheumatoid arthritis, or osteoarthritis. Some hip pain patients are often in the dilemma of seeking for medical help and waiting for the change of their condition with anxiety after the doctor made the suspected diagnosis of femoral head necrosis. There is no effective treatment for osteoarthritis, and once the disease is diagnosed, patients have to wait until the end of the disease to receive hip replacement. The other part of the disease that cannot be diagnosed is generally attributed to “synovitis”.  With the advancement of arthroscopic techniques and equipment, hip arthroscopic surgery has been developed, and one of the most common conditions causing hip pain, “hip impingement”, has gradually been identified in practice.  Anatomically, the normal hip joint consists of the acetabulum and the femoral head, similar to the relationship between the head and the hat. With the movement of the hip joint, the acetabulum and the femoral head rotate relative to each other. The so-called “hip-acetabular impingement” is a mismatch between the “head” of the acetabulum and the femur, resulting in excess bone at the acetabular rim or femoral head, which causes inappropriate friction between the two during movement. This causes inappropriate friction between the acetabular and femoral cartilage or the labrum of the acetabular rim. The “glenoid labrum” is a ring of fibrocartilage-like structures attached to the acetabular rim, equivalent to the inner cap liner, which helps maintain the stability of the hip joint. Long-term hip impingement can lead to degenerative changes in the hip joint, resulting in osteoarthritis, which is a potential factor for hip replacement. Therefore, “hip impingement” should be treated promptly.  In addition to congenital anatomical abnormalities, most patients also have a history of acute and chronic joint injuries. Similar injuries are common in sports such as soccer, skating, skiing, and dancing. The main clinical symptoms are hip pain, a popping sound when changing hip positions, or a feeling of the joint suddenly getting stuck. The strength of the affected side of the hip decreases, and it is difficult to run rapidly or support one leg. In severe cases, the patient cannot even lie on his or her side. Since “hip and femoral impingement” is still a relatively new term in the orthopedic and sports medicine circles in China, it is difficult for hospitals lacking relevant experience to make a clear diagnosis, and therefore there are many misdiagnoses and mistreatments. The most common misdiagnosis is “femoral head necrosis”, “synovitis”, “sciatica”, “lumbar intervertebral disc herniation “etc.  Minimally invasive hip arthroscopy Advances in hip arthroscopic surgery have not only helped diagnose “femoroacetabular impingement”, but have also made it easier to treat it. Arthroscopy is a truly minimally invasive surgery, in which a special tool is introduced into the joint cavity through only two to three 5-mm incisions to perform the surgery. Under arthroscopic surveillance, the surgeon is able to effectively perform surgical steps such as cleaning the hip cavity, removing the bone fragments that cause impingement, repairing the damaged glenoid labrum, and promoting the repair of damaged articular cartilage. The operation is minimally invasive, and the patient recovers quickly after the operation and can walk on the ground with the aid of crutches at an early stage, generally without affecting the self-care of life. Because there is no damage to the relevant structures, there are few residual sequelae.  In addition to the above-mentioned “femoroacetabular impingement”, arthroscopy can also be used to treat other intra-articular diseases, such as intra-articular “free bodies”, “ligament damage”, “articular cartilage damage”, and “hip impingement”. “Articular cartilage damage”, etc. It can even be used in the treatment of early to mid-stage femoral head necrosis, where the morphology of the femoral head and the quality of the articular cartilage can be determined arthroscopically, allowing for an adequate assessment of the disease and prognosis. Arthroscopic drilling and decompression of the femoral head is also an effective means of treating early femoral head necrosis.