I'm a 42-year-old woman with early hip arthritis from a condition they call impingement. Right now my treatment options are fairly limited. I can (and will) try physical therapy. Surgery is the only other choice. If I wait 10 years will there be better (less invasive) ways to solve this problem?
Impingement just means pinching. In the hip impingement typically occurs where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket. Since there are always potential problems with surgery, conservative (nonoperative) care is usually suggested for this problem before considering a more invasive approach.
Early diagnosis and treatment has the best chance of a good outcome. The patient is usually interested in pain relief and improving painfree motion, which will in turn improve function. the surgeon has an eye on preventing the development of osteoarthritis.
A physical therapist can help by showing you ways to move without causing the painful pinching. Activity modification is often needed. This doesn't mean you can't do all the things you want to do. It usually means you have to change the way you go about certain activities. This is often successful with a little time, attention, and practice.
If it has been decided that surgery is the way to go, the surgeon has three choices: 1) full open incision and correction of the problem, 2) arthroscopic surgery, and 3) osteotomy. With the fully open surgical procedure, the head of the femur is dislocated from the socket to make the changes and corrections. With arthroscopic surgery, dislocation is not required. Osteotomy (reshaping the socket) is done for pincer-type impingement.
Whenever possible, the surgeon tries to save the hip. But when there is extensive damage to the cartilage, hip resurfacing or total joint replacement may be needed. There are many factors to consider when making this decision. The patient's age, findings on imaging studies, type and severity of deformity, and presence of arthritic changes are important.
The best time for surgery isn't known. Delays may result in even worse cartilage damage that can't be repaired. But waiting can also give you a better chance for the development of better choices in the future, such as cartilage grafting or computer-assisted surgery. Less invasive approaches to hip surgery are being developed all the time. Young patients with minimal signs of osteoarthritis may want to take the chance and wait to see what comes in the future.
Paul E. BeaulÃ©, MD, FRCSC, et al. The Young Adult with Hip Impingement: Deciding on the Optimal Intervention. In
The Journal of Bone & Joint Surgery
. January 2009. Vol. 91-A. No. 1. Pp. 210-221.
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