Hip

Femoroacetabular Impingement (FAI)  

FAI, also called Femoroacetabular Shock, consists of an abnormal bone growth along one or both of the bones forming the hip joint, causing rubbing and friction between them. This can lead to an increased risk of osteoarthritis of the hip due to the deterioration of the cartilage and labrum.

There are 3 types:

• Cam impingement is a result of a not perfectly round femoral head which causes groin pain as the femoral head cannot move smoothly in the hip socket.
• Pincer impingement is an excessive bone growth where the acetabulum creates an overhang over the femoral head which causes pain in flexion and rotational movements.
• Combined impingement is when both conditions exist at the same time.
  

Treatment

• Arthroscopic surgery -  treats most FAI conditions. It is used to clean out damage to the labrum and articular cartilage, correct the deformation and to preserve the labrum or have it reinserted if possible. 
• Pincer impingement is an excessive bone growth where the acetabulum creates an overhang over the femoral head which causes pain in flexion and rotational movements.
• In certain severe cases open surgery may be required to accomplish the correction.
  

Labral Injuries

The labrum is formed by fibrocartilage (collagen) that surrounds the acetabulum (hip socket) and gives stability and proprioception for gait and fine movements of the hip. Injuries usually occur in the anterior and superior part of the hip as a result of injury, wear and tear and are often related to Femoroacetabular impingement.

Treatment

• Conservative - consisting of anti-inflammatories, physiotherapy and intra-articular infiltrations such as corticosteroids, Platelet-Rich-Plasma (PRP) and hyaluronic acid.
• Surgery - used for labral repair, debridement or reconstruction and can be performed by hip arthroscopy.

Cartilage Injury

Chondral, osteochondral or cartilage injury occurs from degenerative conditions or trauma. If the injury is extensive and affects the entire cartilage it is considered to be osteoarthritis.

Treatment

• Conservative - involves modifying daily activities, rehabilitation and infiltrations with corticosteroids, Platelet-Rich-Plasma (PRP) and Mesenchymal Stem Cells.
• Surgery - diagnostic and therapeutic arthroscopy is indicated for labrum inuries and loose bodies, it is not indicated for arthrosis.

Hip Replacement

Hip replacement surgery is recommended when all other treatment options have failed to provide pain relief. The whole hip joint or parts of the joint are replaced with a prosthesis made from metal, ceramic and plastic components. 

Types:

• Partial Hip Replacement is a procedure where half the hip joint, the femoral head, is replaced. It is only used for femoral neck fractures in elderly people who are not very active. It is usually not indicated in osteoarthritis as it produces great wear of the acetabulum.
• Hip Resurfacing is a procedure where the femoral head is trimmed and capped with a metal covering. This is typically used for active, sporty young people. The main advantage is the preservation of the femoral neck and minimizing bone removal providing greater stability to the hip joint and a shorter recovery time. There is a disadvantage, although low, of femoral neck fracture.
• Total Hip Replacement is a procedure where the whole hip joint is replaced with a cemented component that is fixed to the bone. Hip replacement surgery removes the damaged joint lining and replaces the joint surfaces with an artificial implant. Several components and materials comprise a hip prosthesis ranging from highly polished strong metal-polyethylene to ceramic and plastic.