Evolving Treatment for Hip Injuries

Adapted from the Spring 2013 issue of Discovery to Recovery

The HSS Center for Hip Preservation was established in 2009 to lead the way in early diagnosis, management, and treatment of hip conditions. Among the first to offer a multidisciplinary approach to hip care, preservation, and treatment as well as education and research, the Center brings together a nationally recognized team of specialists committed to joint-preserving treatment options.

In addition to providing the most advanced nonsurgical and surgical care for patients, the Center’s physicians and surgeons work hand-in-hand with scientists to design and implement registries and clinical trials to generate innovative approaches to diagnosis and treatment.

Hip Outcomes Registry

Registries allow us to track how patients do over time, helping our doctors to improve patient care. The Center for Hip Preservation Outcomes Registry was designed to capture and evaluate the outcomes of different types of treatment for non-arthritic hip pain – from nonoperative to minimally invasive and open surgery – in patients under the age of 40. Established in 2010, the registry is currently tracking nearly 5,000 patients at regular intervals following treatment.

Hip Impingement and Arthritis

One common cause of hip pain that is treated at HSS is femoroacetabular impingement (FAI), which occurs when the ball of the hip (femoral head) does not have its full range of motion in the socket (acetabulum) due to excess bone. Using data obtained from the Outcomes Registry specialists at the Center for Hip Preservation hope to shed light on the relationship between impingement and arthritis, and answer the questions: Does impingement lead to osteoarthritis of the hip? Does impingement surgery delay or prevent the development of arthritis?

The classic technique for treating impingement has been open surgery, in which a bony protrusion on the femoral head is rounded to improve its fit in the socket. Over the last 15 years, however, arthroscopic techniques have evolved, providing minimally invasive approaches to treatment.

“We’re constantly trying to identify the best way to approach treatment for each individual patient, so that each will have the optimal outcome,” says Bryan T. Kelly, MD, co-director with Ernest L. Sink, MD, of the Center for Hip Preservation and associate attending orthopedic surgeon at HSS.

“The relationship between our ability to delay or prevent osteoarthritis through surgical intervention is really one of the primary goals of hip preservation. We’re trying to preserve the hip rather than replace it, or at least delay the need for replacement,” he adds.

Understanding Motion Limitations

Dr. Kelly and his colleagues are also in the process of studying the gait difference between patients with FAI and those with normal anatomy as part of a clinical trial.

Bone friction caused by FAI can result in damage to the soft tissue that lines the hip socket, called the labrum, causing pain during common daily activities. It is unclear how the abnormal bone and soft tissue injury affect the muscles around the hip, and why this condition causes a change in walking patterns and movement. Patients enrolled in the study are tested at the Leon Root, MD, Motion Analysis Lab, where the movement of people with FAI is compared to that of those with normal hip anatomy.

This study will clarify how selected hip muscles contribute to different motions. Understanding the reason for motion limitations in patients with FAI will help HSS physician-scientists develop more effective nonsurgical treatments and post-operative rehabilitation plans for patients with hip pain.

Future Promise for Patients

Through the study of appropriate treatment selection, techniques, and outcomes for patients with hip conditions, physician-researchers at the Center for Hip Preservation at HSS are making significant advances in care that will benefit HSS patients as well as others. “In the future,” noted Dr. Kelly, “our collaborative research and clinical innovations will broaden the scope of care that can be provided to patients around the world.”

Read the full Discovery to Recovery Spring 2013 issue.



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