Hip Injuries and Treatments in New Jersey

When taken into consideration with other joints in the body, the hip is a model of stability.

NJ Hip Doctors and Surgeons

The hip is surrounded and protected by the large muscles of the thighs, buttocks and lower back. In fact, NJOI doctors treat many high school athletes in their capacity as team physicians yet there is only a rate of 5-9% of hip injuries in that population.

Hip Pain and Injuries

Of the general population with hip ailments, most are arthritis-based.

Athletes, however, can have hip pain caused by direct impact and overuse syndromes. Other hip problems can be caused by a variety of sports injuries, including groin and hamstring pulls and strains, IT band syndrome, hip pointer, osteoarthritis, bursitis, stress fracture and injuries of the iliopsoas and piriformis muscles. These can be caused by sports with explosive movements, trauma from a hit or fall, or by overuse. Femoroacetabular impingement (FAI) is a hip injury caused when abnormal bone growth on both the femur (the large bone in the upper leg) and the acetabulum (the socket part of the pelvis) repetitively make contact each other. It is common among elite athletes (such as Alex Rodriguez in baseball and among pro hockey players), as well as among generally active people.

Many hip injuries can be treated with conservative measures, such as physical therapy and injections. When nonsurgical methods have been exhausted, the experts at NJOI can perform hip arthroscopy, hip resurfacing (an alternative to total hip replacement) or hip replacement surgery, when necessary.

Common Conditions

Procedures

Labral Repair, Femoroacetabular Impingement (FAI) with Femoroplasty and/or Acetabuloplasty

Femoroacetabular Impingement (FAI) refers to a condition in which a bony abnormality of the hip compresses the labrum (fibrocartilage around the hip socket) or the articular cartilage (protective covering over the hip joint surface) subsequently causing pain. This abnormality can affect the femoral side of the hip (the ball of the femur or thigh bone), the acetabular side (hip socket), or both.

There are two distinct forms of hip impingement: too deep or over-coverage of a socket, known as Pincer impingement; and a non-rounded femoral head, known as Cam Impingement.

Pincer Impingement occurs when the socket covers too much of the femoral head, so that as the hip moves, the labrum comes in contact with the femoral neck just below the femoral head.

Cam impingement, which involves the femoral side of the hip, is the result of an abnormally shaped femoral head being forced into the socket. Since the head is not round, it causes damage to the articular cartilage and the labrum through a “cam” type mechanism (like a rotating wheel in manufacturing).

This can be caused by an acute injury (e.g. hip dislocation) or may occur over time. It is common in athletes who perform twisting motions (such as baseball and tennis). Impingement can lead to labral tears and eventually advanced progression of osteoarthritis.

Some hips have Combined Impingement, which is both Pincer and Cam Impingement. During hip motion, the non-rounded femoral head and socket can continually meet and rub against each other, causing pinching or entrapment of the labrum, commonly leading to a labral tear or wear and tear on the joint.

The arthroscopic treatment of hip disorders, such as that performed by the experts at NJOI, has gained popularity in recent years as technological advancements have allowed for repair of the labrum with suture anchors as well as the treatment of the offending Pincer and/or CAM lesion.

A femoroplasty is performed in the event of a Cam Impingement. It consists of using small instruments to remove the bony abnormality on the femur and reshape the femoral head and neck junction into a normal, spherical shape. In addition, the arthroscopic procedure known as an acetabuloplasty can trim the overhang of the acetabular rim (where the head of the femur meets with the pelvis). Both procedures help restore the ability of the ball-and-socket joint to move in all directions without the friction of impingement, and thus a return to normal function.

Sports Hernia Repair

A sports hernia is a complete or partial tear of the abdominal and groin musculature. It is not a true hernia, but rather, a failure of the muscle-tendon structure. However, it may present with similar symptoms as a true hernia. Athletic pubalgia refers to the numerous groin and abdominal syndromes that affect athletes.

Sports activities that involve planting the feet and twisting with maximum exertion can cause a sports hernia. The injury is triggered by quick movements—such as twisting, turning, sprinting, bending forward, kicking, and doing sit-ups.

The sports medicine experts at NJOI treat sports hernias and athletic pubalgia with directed conservative treatment according to the athlete’s specific diagnosis. In cases where treatment of the damaged muscles, nerves and/or tendons do not respond to conservative care, the surgeons at NJOI perform sports hernia repair to allow the athlete to return to his/her sport.

According to the American Association of Orthopaedic Surgery, more than 90% of patients who initially receive non-surgical treatment and then ultimately surgery are able to return to sports activity.

Iliotibial Band (ITB) Lengthening

Ilotibial band (ITB) lengthening, or release, is a procedure that lengthens the iliotibial or IT band, the strong fibrous band that runs down the outside of the leg and knee. Excessive tightness of the IT Band or painful snapping of the IT Band is treated with a careful multidisciplinary plan. If this conservative treatment does not alleviate the patient’s problems then the the problem may be addressed arthroscopically by the physicians at NJOI. With this procedure, the arthroscopic instruments are inserted through portals on the lateral side of the hip, and a pattern of small incisions is made in the ITB to allow it to lengthen itself and release some of the tension that causes popping and pain.

Bursitis and Abductor/Gluteus Medius Repair

Bursitis is caused by inflammation of a bursa, which is a small jelly-like sac that usually contains a slight amount of fluid. Bursae are located throughout the body and act as cushions between bones and the overlying soft tissues. They help reduce friction between the gliding muscles and the bone. At NJOI, we deal with various forms of bursitis, specifically in this case the two major bursae of the hip, the trochanteric bursa and the ischial bursa. The physicians at NJOI perform ultrasound guided injections to target these bursa directly to maximize the effectiveness of the medications. For refractory cases the surgeons at NJOI can remove the affected bursa through small portals (incisions) arthroscopically.

The gluteus medius is a muscle on the outside of the hip, which is important for abduction (lateral movement away from the body). These muscles help a person stand up properly and walk smoothly (without a limp).

Gluteus medius tears, also known as the rotator cuff tear of the hip, involve tearing of the gluteus medius muscle from its attachment to the greater trochanter, which is often referred to as the “lateral hip bone”.

Greater trochanteric hip pain is a common ailment of middle-aged adults. Various studies estimate a prevalence of up to 15% in the population, with an incidence of 1 in 500 persons. Women have more than a three-fold increased risk compared to men, with the typical age in the 50- to 60-year range. Patients often complain of chronic pain and tenderness over the affected greater trochanter. Walking, climbing stairs, or lying on the affected side usually worsens the symptoms.
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In the event of a gluteus medius tear, arthroscopic surgical repair may be indicated. With this procedure, small anchors are inserted at the normal gluteal attachment site on the hip and sutures attached to the anchors are used to secure the torn tendon into a position to allow for healing.

Proximal Hamstring Repair

The proximal hamstring (or very high hamstring) is a common location of athletic injury. Athletes participating in sports that require sprinting, jumping, acceleration and deceleration are at increased risk. One of the most frequently encountered injuries in sports medicine is strain of the proximal hamstring at the myotendinous junction (MTJ) (MTJ is any site at the connection between muscle and tendon).

Hamstring strain is caused by a wide range of sporting activities with the vast majority of these injuries responding well to non-surgical treatments. In contrast, a complete rupture of the proximal hamstring, while a more rare condition, is often repaired with open or arthroscopic surgery depending on the tear type and location. This is because of the significant structural damage and consequent disability caused by this injury.

Complete avulsions (tearing or pulling away) result in significant or complete loss of hamstring function depending on how many of the tendons are avulsed. This can lead to poor leg control and even difficulty in walking.

Surgical repair is performed by suturing the torn tendons to suture anchors placed in the bone at the anatomical origin. At NJOI, we always opt for the most conservative measures possible. However, in this case, surgical repair of complete, acute avulsions results in significantly better reported outcomes, including rate of return to pre-injury level of sport, and strength and endurance.

In one study, 34 patients underwent surgery for acute proximal hamstring tear. All of the athletic patients were able to return to their pre-injury activities after a mean of 5.7 ± 1.6 months (2.3-9.3 months). http://www.sciencedirect.com/science/article/pii/S1877056812001466

Total Hip Replacement

Hip replacement surgery, also called total hip arthroplasty, involves use of a prosthesis consisting of a ball component, made of metal or ceramic, and a socket, which is composed of plastic, ceramic or metal. The implants used in hip replacement are biocompatible, meaning they are designed to be accepted by the body, and they are constructed to resist wear or corrosion.

Major advances have occurred in hip replacement since the procedure was first approved by the FDA 40 years ago. Particularly in the past decade, newer materials have increased the probability that current hip replacements will last even longer than they did in the past.

Hip replacements patients are typically people with hip joint damage from arthritis or from an injury. With healing and diligent rehabilitation, a hip replacement can relieve pain and restore full function to the hip joint.

NJ Hip Doctors and Surgeons

The NJ hip specialists at The New Jersey Orthopaedic Institute are experienced in both surgical and non-surgical interventions of hip injuries and conditions including labral tears, FAI, cartilage damage, arthritis, fractures and many others. Contact us today to schedule an appointment. Serving patients in Wayne, Clifton, Butler, Bridgewater, Morristown and surrounding areas in New Jersey.