NEW YORK—September 22, 2009
Recent improved understanding of hip abnormalities, combined with advances in diagnostic imaging techniques and minimally invasive surgical treatments are giving many patients new hope for relieving chronic, misdiagnosed hip pain.
Increasingly, hip specialists are now able to slow or reverse the progression of degenerative hip disease, get patients back to their chosen activities and, in some cases, reduce the need for more extensive surgeries, according to doctors at Hospital for Special Surgery (HSS). With this changing paradigm increasingly apparent, HSS announced it has formed the new Center for Hip Preservation, aimed at providing individuals experiencing hip pain with proper diagnosis and treatment.
"In the past few years, the understanding of hip structural abnormalities has increased, allowing specialists to better identify underlying hip conditions that previously went unrecognized and to more accurately diagnose hip problems," said Douglas E. Padgett, M.D., chief of the Hip Service and co-director of the newly formed Center for Hip Preservation at Hospital for Special Surgery. "Health insurance companies also now readily recognize the value of hip preservation procedures and, depending on one's coverage, reimburse their cost."
An increasing number of patients are now being seen at the Center for Hip Preservation. They range from active people at varying stages in life to major league baseball players, hockey players and other elite athletes. The common complaint is limited mobility due to undiagnosed or misdiagnosed hip pain, according to Bryan T. Kelly, M.D., sports medicine orthopedic surgeon and co-director of the Center for Hip Preservation at Hospital for Special Surgery.
In 2002, HSS surgeons started using hip arthroscopy, a minimally invasive treatment option, which may be a better choice for some patients than open, invasive surgery for hip impingement. Through three tiny incisions, doctors are able to trim bone using a burr or spinning drill. Previously, surgeons only had the option of opening up the entire hip with a large incision, dislocating the hip and then shaving the bone down.
Hip conditions can be attributed to anatomical abnormalities that begin at a young age or result from overuse through repetitive motion, as seen in baseball. Femoro-acetabular impingement (FAI), also known as hip impingement, occurs when there is a change in the bony form of the hip joint, causing a decreased range of motion and pain. It is not uncommon for doctors to misdiagnose hip impingements and dysplasias as growing pains.
Unfortunately, a young patient with persistent hip pain who is not properly diagnosed and treated may face early arthritis and eventually require a total hip replacement. In young, active adults, hip disease may have previously been diagnosed as a sports hernia or groin pull. Doctors at the Center for Hip Preservation use an interdisciplinary approach, combining the expertise of a range of professionals, including orthopedic surgeons, nonsurgical sports medicine physicians, radiologists, physiatrists and other musculoskeletal health professionals.
"At HSS, orthopedic surgeons have the long-term expertise to properly identify and treat these conditions earlier to help people return to their active lifestyles," said Dr. Kelly. "Sometimes individuals go more than two years from when their symptoms first start to when they receive an accurate diagnosis."
The Center employs advanced imaging MRI (magnetic resonance imaging) technologies that enable highly experienced musculoskeletal radiologists to accurately pinpoint the problem and help to provide a clear diagnosis. HSS radiologists and surgeons rely on a variety of imaging techniques such as MR arthrography, special ultra-high-resolution MRIs or 3-dimensional CT scans that can provide a more complete and accurate image that can aid in properly diagnosing a patient.
"Past studies have shown that conventional MRIs can have a 42 percent false-negative interpretation for hip conditions," said Dr. Kelly1. "The skilled radiologists at HSS are able to develop and use advanced imaging they have specifically created for this area to help accurately identify problems. The proper diagnosis then allows us to recommend the best treatment, whether it is operative or non-operative."
Not every patient with hip pain requires surgery. The Center for Hip Preservation also offers nonsurgical approaches such as physical therapy or anti-inflammatory regimens. These conservative treatments have been successful in reducing hip pain and swelling in the joint when surgery is not deemed necessary.
At present, little data exists on the long-term outcomes of certain hip procedures such as hip arthroscopy. But as health care spending continues to climb and health policy analysts scrutinize costs, some observers suspect earlier diagnosis and treatment of hip pain may help reduce hip replacement health care costs in the future, according to Dr. Padgett.
While individual specialists throughout the country may be gathering their own data, the Center for Hip Preservation at HSS will be pooling data from a large group of surgeons to build a comprehensive registry to evaluate the short- and long-term outcomes of hip patients seen at the Center.
"We need to be able to understand patterns in the long-term outcomes of certain hip procedures used to treat conditions like hip impingement and dysplasia," added Dr. Kelly. "This registry will provide us with greater understanding of whether these types of surgeries help delay the progression of diseases like arthritis in the hip."
"Because proper diagnosis of hip pain is challenging, the Center will help to gather and share our expertise in this area to educate primary care physicians and physical therapists about the symptoms and early signs of hip problems," said Dr. Padgett. "With a greater understanding of hip pain overall, we can help prevent long-term damage to patients due to missed or undiagnosed hip conditions."
Another focus of the Center is continuing education programs for the broader medical community geared towards recognizing hip conditions and understanding when specialized care is needed.
HSS will play host to leading surgeons from around the world at the 2009 scientific sessions of the International Society of Hip Arthroscopy (ISHA) when it meets at the hospital’s conference center October 9 and 10, 2009. The ISHA is an organization committed to advancing hip pain treatment and hip preservation.
"We are honored to be hosting this second global meeting of the International Society for Hip Arthroscopy, which will be the first time it’s held in the United States," said Robert L. Buly, M.D., attending orthopedic surgeon at Hospital for Special Surgery and course director of the ISHA meeting. "The meeting brings together leading surgeons from all over the world to take an in-depth look at hip arthroscopy and its potential benefits."
1Byrd JW, Jones KS: Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004; 32(7):1668-74.