For active adults, a procedure to ease hip pain

Elizabeth Strumpf, an avid skier, took a tumble last year on an expert trail. When she got up, she felt a dull ache in her hip that worsened and grew even more painful after intense exercise or activity. She soon found she could not sit for more than 10 minutes without increasing discomfort.  

"I had pain snaking down the back of my leg just driving my daughter to school," says Strumpf, a mother of two who met her husband, Lance, on the slopes. "Then, at the gym, I started feeling sharp pain in my hip. Eventually, it hurt too much to work out, something I really enjoyed and missed."     

She's now back to her active life and the sport she loves after treatment by Justin Saliman, MD. The Cedars-Sinai Orthopaedics surgeon ran tests, including a contrast MRI, finding Strumpf showed signs of femoral acetabular impingement (FAI) – a condition in which the irregular shape or rough edges of the femur (thigh) bone rubs or pinches soft tissue in the hip joint. This can lead to fraying or tearing of surrounding cartilage, causing pain and damage that may develop into arthritis or prompt the need for major surgery.

While anyone may develop it, the athletic are more susceptible to FAI, experts say, because they jump, stretch and flex more. Its symptoms include: pain or aching in the inner hip or groin area; difficulty sitting for long periods of time; discomfort leaning over to put on shoes; locking or clicking in the joint; and lower back pain.  

"The condition often goes unrecognized by physicians and patients don't always get the right diagnosis. Often, they're treated for presumed sprains or strains and told to stretch more, which can make symptoms worse," Saliman explains.  

A less invasive procedure

Saliman addresses the condition by reshaping the rough or impinging edges in the joint, and, when possible, cleaning up or repairing cartilage already compromised in the area. This all is done in a minimally invasive arthroscopic procedure, in which surgeons – guided by a tiny television camera – can go via a small incision into the joint to do their work with special tools.

In Strumpf's case, Saliman found a tear already in the cartilage lining the socket in her right hip. She underwent an FAI procedure in the outpatient surgery center in November 2010. After three months' recovery, she resumed activities and immediately went on a ski weekend, taking care to stay on easier trails.

While long-term studies on FAI surgery are under way, Saliman – who performs four or five of the procedures each week – and other orthopedists nationwide say it can prevent further damage, slow arthritic development and possibly reduce the prospect that some patients later will need full hip replacement.

Patients walk with crutches for a week or two before starting physical therapy. While moderate exercise is encouraged, it takes four to nine months for the hip joint to mend fully. Saliman tells patients to forego competitive sports for six to nine months after surgery.

"That can be tough for people whose lifestyles included weekly soccer games, regular 10Ks or softball tournaments, but the joint will be stronger if they stick to the recovery plan," he says.