New York City—July 15, 2010
“This study demonstrates that there is high rate of return to pre-injury level of function with arthroscopic intervention,” said Bryan Kelly, M.D., sports medicine orthopedic surgeon and co-director of the Center for Hip Preservation at Hospital for Special Surgery. “Before this study we knew that hip impingement occurred in athletes, but we were not certain as to the degree of our ability to treat this arthroscopically with a successful return to full function.” He says arthroscopic surgery provides a viable alternative to open surgery and may allow for a faster recovery without compromising ultimate function in appropriately selected patients. Dr. Kelly will be presenting the study (abstract 9291) at the AOSSM meeting.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis.
While this syndrome can affect anyone who is genetically disposed to develop the condition, symptoms often appear earlier in those who are athletic. Athletes with the syndrome often present with complaints of pain, decreased range of motion, and the inability to perform at a high level of competition. “In athletic activities which require a high degree of motion and significant force through the joint, there can be earlier onset of symptomatic injury,” Dr. Kelly said.
Previously, a few small studies had shown that hockey players could successfully return to play after undergoing arthroscopic surgery for FAI. To find out if this was the case with other athletes, investigators at HSS launched a study involving athletes from a variety of sports and in a much larger population. Investigators looked through the records of high level athletes at HSS who underwent arthroscopic surgery for FAI and had a minimum of one year of follow-up. Patients who had FAI in both hips were excluded.
Investigators reviewed demographic characteristics of the athletes, X-rays, and data collected during the operations. An independent blinded examiner recorded athlete’s strength after the operation, range of motion, and complications. All patients completed questionnaires that measured hip-specific outcomes including the Modified Harris Hip Score (MHHS) and Hip Outcome Score. Investigators also collected information about how soon athletes were able to return to play, return to competition, and return to the same level of competition they were at before they started having problems.
In all, doctors scrutinized records of 47 patients; the average age was 22.8 years, with a range of 17 to 56 years. The average follow-up was 16.4 months. Athletes from a variety of sports were represented including ice hockey (11), soccer (7), baseball (6), swimming (4), lacrosse (4), field hockey (4), football (4), running (3), tennis (2), crew (1), and horse back riding (1). Slightly over half, 53.8%, were college varsity level athletes; 26.9% played varsity high school and 19.2% were professionals. Thirty-three patients or roughly 70% were available for follow-up.
X-rays showed an improvement in the anatomy of the hips, and investigators identified statistically significant improvements in the average MHHS scores before surgery, 68.6, compared with the post-op scores, 88.5. “The MHHS score is a subjective outcome score that is used to measure the level of patient performance or ability to do certain activities on a scale of 1 to 100, with 100 being unlimited function and one not able to do anything,” Dr. Kelly said. Hip Outcome Scores, also measured using a similar scale, also improved from 78.8 before surgery to 91.4 after surgery.
Seventy-eight percent of patients were able to return to play after hip arthroscopy at an average of 9.4 months after surgery, and 91.7% were able to return to the same level of competition. Only two patients were unable to return to competition due to persistent hip injury. Dr. Kelly says there are no large studies assessing return to play after open surgery for FAI, but it is thought that the results would definitely not be as good given that open surgery is much harder on the body.
The researchers say that arthroscopic treatment of FAI allows a large percentage of athletes to return to a high level of competition and is a good alternative to open surgery in the appropriate patient. This is important given arthroscopy surgery has a number of advantages over traditional open surgery. “Although technically challenging, appropriately performed arthroscopic surgery results in less soft tissue trauma, less blood loss, shorter hospitalizations, and likely provides a faster return to a full recovery,” Dr. Kelly said.
Other authors of the study are Shane J. Nho, M.D., Christopher Singh, B.A., and Erin Magennis, B.A., from Hospital for Special Surgery.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.