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 the Hospital for Special Surgery (HSS). With this changing paradigm increasingly apparent, HSS announced it has formed the new Center for Hip Pain and 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 Pain and 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 Pain and 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 Pain and Preservation at Hospital for Special Surgery.
"Advances in imaging technology and new hip preservation surgery have also helped to better recognize and treat conditions such as hip impingement, labral tears and hip dysplasia," said Dr. Kelly.
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.
A Network of Resources and Specialists 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 Pain and 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. Kelly . "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 Pain and 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.
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