Everything from getting out of a chair to running requires your hip – a complex structure that consists of two bones, a joint between them, and muscles that generate strength and motion.
Hip problems can be caused by overuse, traumatic injury, and/or naturally occurring bodily changes, and can affect the back and knee. These include:
- Bone Spurs/Impingement
- Soft tissue damage
- Less common causes include dislocation, infection, tumors, or nerve problems
Suffering from hip pain? Contact us to learn about treatment options.
How Your Hip Works
The hip consists of two bones: the thighbone (femur) and the hip (pelvis), which come together to form the hip joint.
The thighbone is a long bone that runs from the knee to the hip. Its ball-shaped head fits neatly into a socket on the hip. The socket is lined with a flexible rim of soft tissue called the labrum, which helps increase stability. A joint capsule surrounds and strengthens the hip joint.
Many small muscles surround the hip joint and work together to turn the leg in (internally or medially rotate) or out (externally or laterally rotate).
The large gluteal muscles let the leg move backward. The hip flexors in the front of the leg help bring up your leg so you can do things like climb stairs.
For the hip to function properly, bones, joints, and muscles must work in unison.
Certain hip conditions may require surgery – especially if conservative treatments haven’t been successful. For example, a labral tear often requires torn tissue to be surgically reattached to the bone or cleaned up to stop popping, clicking, or catching.
Surgical advances now allow us to treat previously untreatable conditions and make treating other conditions easier and safer.
Hip surgeries other than a total joint replacement – including impingement, bony defects, and labral tears – can be done arthroscopically. Often, arthroscopic hip surgery can address multiple hip conditions simultaneously.
A surgeon and a physician’s assistant will lead your surgical team in the operating room.
Once you’re fast asleep in the operating room, your hip is filled with saline, to expand your joint and make it easier for your surgeon to move instruments and see tissues. To see inside your joint, your surgeon uses a special table that separates your thighbone from its socket on the pelvis. Your foot is strapped into a boot that pulls your leg away from your pelvis, creating more space in the hip joint for surgical instruments.
At that point, your surgeon inserts an arthroscope — a tiny camera connected to a large monitor that lets your surgeon clearly see the structures in your hip.
Once your surgeon can see in the joint, they’ll insert surgical instruments through another incision and repair damaged tissue. Often, multiple tiny incisions are made to get to different areas in your hip. While in your hip, your surgeon will usually fix any repairable damage they find, even if it was unexpected.
Even MRIs can miss damage, but during an arthroscopy, your surgeon can see what’s problematic.
You’ll be placed on crutches until you regain full sensation in your hip, can bear full weight on your leg, and can walk comfortably. If a repair is needed or more intensive work was done, you may need to not put any weight on the leg for a few weeks.
If you’re having a hip replacement, talking with our joint coordinator can help alleviate some of your post-surgery concerns.
Sometimes you can begin moving your hip and returning to activities on your own, as you feel able; other times you may require physical therapy.
It takes most patients one to two months before they’re back to daily activities. Labral repairs can take up to three or four months before patients are back to regular activities; however, it can take up to a year before they no longer notice hip pain.
Conditions Where Surgery May be Necessary
The hip joint’s bony surfaces are covered by smooth, hard cartilage. Hard cartilage defects or flaps can cause a painful catch or click, limit hip motion, and potentially damage healthy hip tissue.
Relatively small defects can sometimes be polished and smoothed with gentle motion exercises like riding an exercise bike. Severe hard cartilage damage may require surgical intervention to remove unstable tissue flaps.
A hip chondroplasty removes fraying or flapped hard cartilage and smooths down remaining tissue. After this procedure, you’re often placed on crutches for a few days and can wean from them gradually. Your surgeon will outline your post-surgery restrictions.
The labrum helps increase the hip’s stability, but it can fray or completely tear, causing a flap of tissue to catch within the hip joint. This leads to pain, popping, and a feeling of instability.
This condition can be treated arthroscopically. Minor labrum damage may only need a debridement, where a surgical instrument removes the fraying or flapped labrum and smooths down remaining tissue. After a labral debridement, you are often placed on crutches and can wean from them as you tolerate.
For a completely torn labrum, your surgeon will often use anchors made of a bone-like substance to sew your labrum down to the bone. Over time, your body turns the anchors into bone. The number of sutures used during surgery will depend on the size and severity of your injury.
You’ll be given specific post-op instructions after a labral repair, but expect to use crutches for up to six weeks. Your surgeon will outline your restrictions are after surgery.
Femoral acetabular impingement (FAI) occurs when bone spurs form in the hip, causing abnormal motion within the joint and rubbing on the hip socket, which damages the hard cartilage on the bone or the soft-tissue labrum. This typically occurs in young and middle-aged adults.
There are two types of FAI, depending on whether the bone spurs form on the thigh bone or the hip socket. Both can cause pain, limit motion, and damage other structures in the hip.
During arthroscopic hip surgery, your surgeon will go in the hip joint and remove any bone spurs or excess bone. Your surgeon may use fluoroscopy, a special type of X-ray, to determine when they’ve restored an appropriate shape to the hip socket and/or thigh bone.
Sometimes labrum repair is necessary. Any damage to the surrounding soft tissues in your hip joint will also be debrided or cleaned up.
After a femoroplasty, you’ll use crutches for the first few days and then can walk as tolerated. Your surgeon will outline your post-surgery restrictions.
Initial recovery for a femoroplasty is relatively short; however, the surface where the spur was removed can be sore for a few months following surgery, as it takes time for your body to develop a new hard covering on the bone. This procedure is typically very helpful and bone spurs rarely return.