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Jesús Zorrilla Ruiz
Clínica Universidad de Navarra
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Clínica Universidad de Navarra

2008/9/17

Minimally invasive surgery cures pain caused by hip impingement

The pain due to injury caused by an impingement within the hip joint can be alleviated by means of two surgical techniques in a minimally invasive manner. Arthroscopy is the technique preferred for those cases where the injury is less serious while the femoroacetabular osteoplastica after a small incision is for more serious injuries, according to doctors Juan Ramón Valentí and Pablo Díaz de Rada, director and consultant, respectively, at the Department Of Orthopaedic and Bone Surgery at the University Hospital of Navarra. 

“The generally accepted notion that hip pathologies only affect elederly people is not correct”– advises Doctor Díaz de Rada -. “About 7- 10 years ago we showed that hip joint injury is predominant amongst young adults who carry out normal sporting activity”. Such hip conditions are accompanied by pain usually assumed to be tendonitis. Nevertheless, it has been shown that the pain arises from a problem with the hip articulation.
The pathology occurs when the head and/or neck of the femur (the acetabular edge) collides or impacts with the pelvic cavity (acetabulum) where this femoral head articulates.

High rate amongst young adults 

Recent studies calculate that the collision or impingement of the hip affects15% of the population, although the majority of cases do not lead to symptomatology. Two thirds of patients affected by injuries are young adults who carry out regular sporting activity. To date the origin of the problem was unknown. However, it is presumed that, with symptoms that are left untreated, it could degenerate into early arthrosis of the hip joint.
The symptoms that indicate the injury known as femoroacetabular impingement are pain in the gluteal region on flexing the leg at the hip with movements such as leg crossing, jumping over hurdles, throwing a ball, martial arts or a very low sitting posture (squatting), amongst others.
The syndrome is produced when excess bone forms around the neck of the femur, and which, on flexing the leg, impinges on the acetabulum edge (ladrum), thus putting pressure on the cartilage. There are also cases where there is no excess bone protuberance at this point but the acetebulum is longer than normal and so, on flexing the joint, the femur neck impacts against the excess bone on the wall of the pelvis and pushes the femoral head outwards, causing pain and obstructing flexion. In most case, both phenomena occur together.
According to the specialist, the symptoms of those suffering from this syndrome are pain in the groin, in the gluteal region, in the thigh or around one side of the hip, on making flexing or rotational movements.

Surgical treatment

 

According to Doctor Díaz de Rada, the surgical treatment basically consisted of milling down the femoral head and the acetabulum “in order to provide the spherical shape that the femoral head should have to avoid rubbing”. To date it was usual for this procedure to be undertaken using arthroscopy in those cases where the excess bone was slight. In cases of greater bone protuberance, open surgery involving larger incisions was carried out and this could give rise to temporary muscle injury and longer recovery time.
.
The current, most effective, alternative for those cases where arthroscopy is not suitable is osteoplastica after a small incision. This involves minimally-invasive surgery effected with an 8 cm incision in the front part of the thigh. “Access is gained between flat muscles and so the effect is much less. The patient can start walking within a fortnight of the operation and, after a period of intense rehabilitation, he or she can continue the high-level sport competition activity within 6 months”, the consultant at the University Hospital of Navarra pointed out.

The operation is carried out with sedation, either with epidural or general anaesthesia, as it is surgery that can last for more than two hours. The patient to be operated on requires hospitalisation of between 3 and 5 days when he or she can walk with crutches. Once over this, the process of rehabilitation can start and, within three weeks, the patient can begin to walk without crutches. Six weeks after the operation, some sports such as swimming can be carried out and, after 6 months, high-level, competition-standard contact sports can be taken on.

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