> Skip repeated content

Arthroscopy and Open Surgery Are Equally Efficacious in Treating Common Hip Problem in Most Patients

Study Identifies Subset of Patients Best Treated with Open Surgery

New York—July 8, 2011

Researchers at Hospital for Special Surgery have found that in comparison to open surgery, arthroscopic treatment of a common hip problem that leads to arthritis produces similar outcomes in terms of repairing structural problems in most patients. The study will be published in the July 2011 TK issue of the American Journal of Sports Medicine.

"For the majority of patients with more typical hip impingement, arthroscopic approaches should be just as effective at adequately restoring the mechanics as the open surgical technique," said Bryan T. Kelly, M.D., co-director of the Center for Hip Preservation (www.hss.edu/hippain) at Hospital for Special Surgery in New York.

In recent years, a hip condition known as femoroacetabular impingement (FAI) or hip impingement has become widely recognized as the most common cause of early osteoarthritis in patients who don’t have arthritis caused by dysplasia (a shallow socket). 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.

This condition can be treated by structural correction of the bone through open surgery or arthroscopic surgery; doctors have been regularly using the latter technique since roughly 2003. Studies comparing arthroscopy against open surgery to treat FAI have shown that the two produce similar outcomes in terms of improving symptoms and returning athletes to their sport of choice. Studies have not, however, examined whether the two surgeries are equal when it comes to achieving structural or mechanical corrections.

To remedy this, investigators enrolled 60 male patients under 40 years of age who had symptomatic FAI. Thirty consecutive patients were treated with open surgery and 30 consecutive patients were treated with arthroscopy. X-rays were taken both before and after surgery. The researchers analyzed angles in the X-rays that determine the roundness of the femoral head, the ball of the thigh bone, and found that for the most part, both surgeries repaired sphericity similarly. They found that the two surgeries also similarly repaired the degree of separation between the sphere of the femoral head and the edge of the socket.

"The short term goal of treating FAI is symptom improvement and return to a higher level of function, but the long-term goal is to improve mechanics across the joint so that the cartilage wears at a slower rate and the health of the joint is preserved longer," said Dr. Kelly. "The ability of the procedure to do that is really based upon precise structural correction. This is the first study in patients to show that we can achieve similar mechanical correction arthroscopically." He noted that they had previously demonstrated this in a study involving cadavers.

In the current study, the researchers did find that one particular angle, called the anteroposterior (AP) alpha angle, was better repaired with open surgery. The AP alpha angle was reduced by 25.7% in the open surgery group and 16.8% in the arthroscopic procedure. This angle also involves the sphericity of the femoral head.

Dr. Kelly said that if doctors determine a patient has a large AP alpha angle, that patient might be better suited for open surgery. "People who have large alpha angles on their AP on the front view X-ray are ones that you might consider alternative surgical techniques to arthroscopy," said Dr. Kelly. "That is one particular location that is hard to get to."

Not all patients with FAI need to undergo surgery. Treatment usually begins with rest, activity modifications, careful use of anti-inflammatory medications, and physical therapy. An injection of an anesthetic and steroid into the hip joint can also provide some relief. If these treatments do not work, surgical treatments are considered.
Other investigators involved in the study include Asheesh Bedi, M.D., former HSS fellow now at the University of Michigan; Ira Zaltz, M.D., William Beaumont Hospital, Royal Oak, Mich.; and Katrina De La Torre, R.N., M.Sc., 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 ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). 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.

 

Need Help Finding a Physician?

Call us toll-free at:
+1.877.606.1555

Conditions & Treatments

adult child
Select A Body Part
Conditions: Adult head Conditions: Adult spine Conditions: Adult shoulder Conditions: Adult elbow Conditions: Adult hand Conditions: Adult hip Conditions: Adult knee Conditions: Adult ankle Conditions: Adult head Conditions: Adult full body Conditions: Child spine Conditions: Child elbow Conditions: Child hip Conditions: Child hand Conditions: Child knee Conditions: Child ankle Conditions: Child full body


Conditions A-Z
A B C D E F G H I
J K L M N O P Q R
S T U V W X Y Z
SEE ALL

Media Contacts

Tracy Hickenbottom
Monique Irons
Sherry Randolph

212.606.1197
mediarelations@hss.edu

Social Media Contacts