Dr. Austin Chen on Improving Painful Hip Conditions

HIP PRESERVATION OFFERS HOPE FOR A RETURN TO AN ACTIVE LIFESTYLE

Research indicates that early intervention for hip issues may slow their progression. Hip preservation is a type of intervention for young, active adults that can improve the structure and function of the hip joint.

With his unique background as a board-certified, dual-fellowship trained orthopedic surgeon, specializing in both hip and sports medicine surgery—and as a US Ski & Snowboard Sports Medicine Physician—orthopedic surgeon Austin W. Chen, MD of BoulderCentre for Orthopedics described the latest hip preserving treatments for non-arthritic conditions during a free online health lecture.

What is Hip Preservation?
“Hip preservation is based on the idea that some common hip problems, when identified early, can be addressed to improve the mechanics of the hip joint,” said Dr. Chen. Hip preservation can be particularly helpful for young athletes and active adults whose activities involve extreme hip motions such as running, cycling, golf, hockey, gymnastics, dancing, basketball or soccer.

Treatments associated with hip preservation include:

• Activity modification
• Physical therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Hip arthroscopy

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VIDEO: Watch Dr. Chen's online lecture on "Improving Painful Hip Conditions."

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Conditions That Can Benefit From Hip Preservation

• Femoroacetabular Impingement (FAI) - more simply known as hip impingement, is a condition that can lead to labral damage, hip pain and instability. “The first sign of FAI often is pain in the groin, on the outside of the hip or in the buttocks. Patients may feel a tightness and a loss in range of motion. With high flexion or rotation, they may also feel a pinching,” said Dr. Chen.
• Hip labral tears - an injury to labrum. It can be caused by trauma, structural or degenerative issues. Symptoms include pain or stiffness. It can be treated non-surgically, or with surgery in severe cases.
• Snapping hip - a condition characterized by a snapping sensation and often a popping noise that occurs when the hip is flexed and extended. In some cases, snapping hip leads to bursitis, a painful swelling of the fluid-filled sacs that cushion the hip joint.
• Hip dysplasia - an abnormality of the hip socket that causes the joint to wear out faster than normal.

The Right Imaging for Determining the Right Treatment
“To be identified as an ideal hip preservation patient, you cannot be experiencing any arthritis in your hip,” said Dr. Chen. “We’ll identify the type of pain you’re feeling and how it’s impacting your daily life and extracurricular activities."

Dr. Chen explained that imaging analysis is one of the tools used to determine if hip preservation is an appropriate solution for a hip condition. These include:

• X-rays—to take measurements and evaluate the shape and risk factors for impingement or instability.
• Magnetic Resonance Imaging (MRI)—to help identify and clearly reveal fraying or tears of the cartilage and labrum.
• Computed Tomography (CT) Scans—“We use these if we’ve identified a bony abnormality,” said Dr. Chen. Used infrequently, this 3D scan indicates where an impingement exists.

"Additionally, we’ll perform a physical, review imaging to understand if it’s truly your hip that’s the issue and determine appropriate treatment,” said Dr. Chen.

All hip preservation patients initially receive non-operative treatment. "They go through a minimum of three months and up to 12 months of non-operative treatment,” said Dr. Chen.

He emphasized a study of non-operative management techniques indicating that “82% of people managed non-operatively experienced significant improvements following two years of treatment. People who addressed their hip issues sooner were likely have a better outcome." He also noted, “If you can modify life enough to live with the condition, that’s always my recommendation.”

Arthroscopic Surgery for Hip Preservation

In some instances, arthroscopic surgery—a minimally invasive procedure—may be required as an effective way to preserve the hip. “It is often used for those who have already tried nonsurgical treatments and haven’t developed significant arthritis,” said Dr. Chen. An orthopedic surgeon will determine when surgery is needed, if you’re a candidate and the appropriate procedure.

“For the hip arthroscopy procedure,” said Dr. Chen, “three to four keyhole sized incisions are made. Recovery starts with physical therapy the day after surgery and typically includes two weeks on crutches and two weeks in a brace.”

This procedure results in quick recovery, minimal scarring and a return to pre-injury activity, making the procedure ideal for athletes and those 20 to 55 years old.

Hip arthroscopy is NOT ideal for those:

• who are older,
• have an elevated BMI and are overweight,
• experience anxiety or depression,
• who have had symptoms for longer than two years, making it harder to fully recover

To request an appointment with Austin W. Chen, MD, at the Boulder Center for Orthopedics and Spine call (303) 449-2730.

To learn more, view/download a PDF of slides shown during this lecture.