Doubts About Hip Arthroscopy

The New York Times

Is hip impingement surgery really necessary?

This was the focus of a front-page story today in The New York Times —  Hip Procedure Grows Popular Despite Doubt, by Gina Kolata.

The article looks specifically at the shaving of the femoral bone, often done in conjunction with the repair of a torn labrum, or cartilage that surrounds and seals the hip joint. It is friction in the joint that causes the tear that results in the inflammation, and often pain, throughout the groin area. (At least this has been my experience with my left hip, and now my right.) By shaving down the bone and removing any growths or spurs and stitching up the tear (with anchors), it is the hope that the patient would be spared further injury to the area as well as the development of arthritis later on.

Numerous professional athletes have had this procedure done arthroscopically, including  Alex Rodriguez, the Yankee third baseman.

But the story calls into question the long-term effectiveness of shaving down bumps or irregular shapes that could be merely “normal variations.”

“One difficulty in assessing the operation’s effects is that it is combined with other procedures to repair torn tissue,” the article states.  “When patients say they feel better, is that because their impingement was fixed or because their torn tissue was repaired, or both?”

The article sites a study recently published in the Journal of Bone and Joint Surgery in Britain by Dr. George Hartofilakidis from the University of Athens in Greece. Dr. Hartofilakidis and his colleagues followed 96 people with an average age of 49, each of whom had a hip impingement but no hip pain, and after more than 18 years found that only 20 percent had developed arthritis.

The Times article, however, sited another study that found a link between hip impingement and arthritis — this one by Dr. John J. Callaghan of the University of Iowa.  The patients in Dr. Callaghan’s study were in their 50s, did not have impingement surgery, and needed hip replacements because they had severe arthritis. Seventy percent had impingement.

So the bottom line seems to be this:  much more research is needed.

And more, it seems, is being done.  My own surgeon at the Hospital for Special Surgery is working on one such study. Having had hip arthroscopy to fix a torn labrum and impingement on my left side over the summer, and with the same procedure planned for my right side in three and a half weeks, you can call me a walking study specimen.