Thursday, September 5, 2013

Hip Cartilage Arthritis Linked to Failed Hip Impingement Surgery

This post is a bit of a mish mash on arthritis. Lots of new research has been published on femoroacetabular impingement, FAI, recently. PubMed is virtually exploding with new entries on hip impingement, FAI.  A few worth mentioning (and I might just come back with a more detailed version) touch upon the topic of why some surgeries to treat FAI fail. Failure isn’t a word patients like to hear, so here is what patients need to know.

Thursday, August 8, 2013

Subspine (AIIS) Impingement - A 'New' Form of Impingement Next to the Hip Joint

By now femoroacetabular impingement (FAI), hip impingement, is well documented in the literature, although far from all orthopedic surgeons are qualified to diagnose and treat hip impingement. But a ‘new’ form of impingement, called subspine or AIIS (anterior inferior iliac spine) impingement is a diagnosis that is increasingly recognized.

Why is this important? Because in patients who have femoroacetabular impingement (high alpha angle and/or version), type II and type III shapes of the AIIS are associated with a decrease in hip flexion and internal rotation.

Tuesday, July 16, 2013

The Relationship between Hip, Sacroiliac and Low Back Pain – Preventing Unnecessary SI Fusions


Hip pain, sacroiliac (SI) joint and low back pain can be intrinsically related.  Previously, I had blogged about distinguishing hip pain from true sacroiliac pain. In light of an increasing number of people going under the knife to fuse their SI joints with the sacroiliac implant iFuse® (an estimated 5,000 people in the United States in 2013), I want to revisit the topic. I want to try to answer the question when SI fusions are warranted and what patients should know.

Monday, July 8, 2013

Iliopsoas Impingement as a Unique Cause of Hip Labral Tears

We know that bony lesions of the femoral head-neck junction (CAM impingement) and of the hip socket (pincer impingement) can cause labral tears. We also know that impingement of the iliopsoas tendon on the acetabular labrum is fairly common in patients with hip impingement (femoroacetabular impingement, FAI). Therefore a partial release, or tenotomy, of the psoas tendon is often performed during hip arthroscopy. Some physicians now say that, in some cases, psoas impingement in itself – without bony impingement – may be the cause of tears of the labrum.

Thursday, June 27, 2013

Outcomes of Surgical Techniques for Hip Impingement, FAI, Surgery

New exciting research is available on surgical outcomes comparing several techniques. Hip impingement (femoroacetabular impingement, FAI) is characterized by bony deformities on the femoral head/neck and/or the acetabulum (hip socket). Some bony lesions may require open hip surgery with dislocation to address large, global lesions. Many CAM and/or pincer lesions can be addressed arthroscopically. But how much do the outcomes vary depending on the various techniques used by hip surgeons?

Thursday, June 13, 2013

Physical Therapy / Rehabilitation after Hip Impingement (FAI) Surgery: The Benefit of Neurokinetic Therapy for Muscle Re-Education

A few weeks back, I mentioned I’d be back with a guest blogger, a physical therapist who uses Neurokinetic Therapy (NKT) in his practice. Here he is. Meet Kristopher Bosch, PT, DPT, ATC, FAAOMPT!

Most rehabilitation and wellness professionals eventually end up asking themselves: “Why do patients/clients come in with pain, go through a treatment session, leave pain-free or with significant improvement noted, and then return the next week with the same symptoms (often times over and over again)?”

Friday, May 24, 2013

Why You Need an FAI Surgeon Who’s Specialized in Hip Impingement: All Orthopedic Surgeons Are Not Equal


Recently, I met someone who had seen an orthopedic surgeon who told his patient that the labrum fills no function whatsoever. He would just cut it out, and the patient was told she would walk out of the operating room like it is nobody’s business. Doctors like this scare me because they clearly do not understand femoroacetabular impingement (FAI or hip impingement) but are happy to slice and dice their patients.

I say it in my book, but it is so important that I want to put it out here on the Internet for the world to read. Just because someone is a board certified orthopedic surgeon does not mean he/she is qualified to perform surgery to remove hip impingement and treat hip labral tears.

Wednesday, May 15, 2013

Diagnosing Pain Generators throughout the Hip Using the Layer Concept

Last week, I gave a very brief introduction to the layer concept in my post Hip Impingement and the Unraveling of Related Diagnoses. I promised you I would dig deeper. Now I have. This post will probably be by far the longest post I will write. In fact, it deserves a book chapter.

The layer concept for diagnosing hip was developed by Dr. Bryan Kelly of Hospital for Specialty Surgery in New York, NY. It is quite fascinating how he details four layers of diagnosis and treatment. I wish every hip patient would get this kind of evaluation. Unfortunately, that’s not the case. But, by educating ourselves, identifying and finding the care we need, many of us might get closer to the Layer Concept and the Hip Center model that Dr. Kelly advocates (see aforementioned blog post).

Wednesday, May 8, 2013

Hip Impingement and the Unraveling of Related Diagnoses

For years now, I’ve been frequenting virtual networking groups on hip impingement (FAI). Many patients get diagnosed, treated, rehabbed and move on with their lives. Unfortunately, some patients get stuck in the status quo, have trouble getting a correct diagnosis and treatment although hip pathology is highly suspected. Yet other times, patients have surgery to treat FAI and labral tears, but problems persist after surgery.

When medical problems overlap, some patients end up dismissed by healthcare providers because their pain picture has become too complex. At times, complex regional pain syndrome or fibromyalgia is diagnosed. In my book I write about how it takes a systematic approach to diagnose someone where pain has escalated beyond just an ache in the hip joint and a clear-cut x-ray, CT or MRI impingement diagnosis, as well as and some strategies patients can apply to reach their goals.

From personal experience, I know how hard it can be to get shuffled from specialist to specialist. So I was excited to find a summary from a recent hip symposium (hosted by The American Journal of Orthopedics) where a number of hot shot hip surgeons gathered to discuss surgical preservation of the hip and how the understanding of complex issues keep developing. For example, the symposium addressed the topic of layers of diagnoses some patients may experience as well as a discussion on sources of impingement.

Thursday, May 2, 2013

Study Reveals Higher Rate of Hip Arthroscopy Complications than Previously Thought

If you are one of all hip FAI patients considering surgery, you might wonder about the complication rates hip arthroscopy. A recent case study on more than 500 hip procedures revealed that complication rates may be higher than previously thought. The researchers – led by Dr. Christopher Larson, MD, of the Minnesota Orthopaedic Sports Medicine Institute in Minneapolis – presented the study results at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day in Chicago, IL.

Tuesday, April 30, 2013

NEW Research: Deep Hip Sockets (Coxa Profunda) Not Enough Diagnose Pincer Hip Impingement - Especially in Women


Coxa profunda means that your hip (acetabular) socket is deep. Until recently, findings of coxa profunda on x-rays have been considered indicative of pincer-type femoroacetabular impingement. A study presented in the American Journal of Bone and Joint Surgery hypothesized that coxa profunda is a very common radiographic finding in females and is not a finding that is specifically associated with pincer-type femoroacetabular impingement. 

Monday, April 1, 2013

Sacroiliac Pain - A Pain in the Butt or the Hip?


If you have pain in your buttocks, you’re not alone. You may have seen doctors who diagnosed you with degenerative disc disease or sacroiliac joint dysfunction. For years, I was chasing the sacroiliac joint dysfunction diagnosis – with massive amounts of physical therapy and even prolotherapy – but nothing ever helped.

I thank my lucky star that not a single doctor suggested the increasingly popular sacroiliac joint fusion procedure. It’s not that maybe some patients benefit from an SI fusion. What worries me are all the patients who get their SI joints fused when the SI joint itself is not the root cause of the problem. 

Monday, February 11, 2013

Perspective on Nerve Injury from Hip Arthroscopy


In my previous blog post, I had cited an article from the Journal of Bone and Joint Surgeons about a study on the relationship between traction weight and sciatic nerve injury during hip arthroscopy. In a subsequent issue of the same journal (November 21, 2012), Dr. Patrick Birmingham, MD, published a commentary on the article called “Risk of Sciatic Nerve Traction Injury During Hip Arthroscopy – Is It the Amount or Duration? An Intraoperative Nerve Monitoring Study” (by Dr. Jessica Telleria, MD).

I wanted to share the commentary with you as it provides some perspective on the topic of potential nerve injury from hip arthroscopy. Dr. Birmingham states

Friday, February 1, 2013

Traction Weight during Arthroscopic Surgery Linked to Sciatic Nerve Damage

An article in the Journal of Joint and Bone Surgery (2012, volume 94, issue 22) presented results from a study performed among 60 patients. Using nerve monitoring during surgery, the researchers studied prevalence, pattern, and predisposing factors for sciatic nerve traction injury during hip arthroscopy. Wow! A majority of patients, 58 percent, had nerve injury during the surgery and 7 percent ended up with a nerve injury after the surgery. 

The results showed that traction weight was a factor in the nerve damage.