When pain stops you from doing what you enjoy, it’s time to find a treatment that helps you regain function and get back to life.

If you’re young, active and healthy, and you’ve lost the ability to live life as usual because of hip pain or injury, this is where you belong. The hip preservation specialists at The Ohio State University Wexner Medical Center will help you return to your active life as quickly as possible.

We want to understand where you’ve been with your condition, what you’ve done to manage it, what your limitations are and the affect your condition has on the quality of your everyday life. We provide compassionate, personalized care using the latest medical advances, including hip arthroscopy and hip-preservation techniques.


Conditions We Treat

Femoroacetabular Impingement

Femoroacetabular Impingement (FAI) is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head (hip ball) and the rim of the

acetabulum (hip socket), which leads to damage to the articular cartilage (lining or gristle) in the acetabulum, or to the labrum of the hip, or both. The labrum is a ring of cartilage that surrounds the acetabulum and looks very much like the meniscus of a knee joint, although its function is different.

Damage to the labrum and/or articular cartilage will likely cause pain. An abnormality in the shape of the femoral head or acetabulum, or both, may cause FAI. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact, such as kicking sports.

FAI generally presents in three forms:

  • Pincer – This type of impingement occurs because extra bone extends out over the normal rim of the hip socket, known as the acetabulum. The surrounding tissue, called the labrum, also can be injured or crushed under the prominent rim of the hip socket.
  • Cam – In cam impingement, the ball portion of the hip bone (called the femoral head) is not round, so it cannot rotate smoothly inside the hip socket. This “bump” on the edge of the hip bone can grind and damage the cartilage inside.
  • Combined – With combined impingement, both pincer and cam types are present.

FAI can affect all age groups from the early teens and throughout adult life and is being increasingly recognized as a factor that may predispose patients to osteoarthritis of the hip. It is felt by many that without early intervention surgery, there is a high likelihood of developing osteoarthritis with the subsequent requirement for either a hip replacement or other major hip operation. Hip arthroscopy can be used to reshape the femoral head and socket to prevent impingement, and aims to protect the hip from developing osteoarthritis, in addition to relieving current symptoms.

When symptoms develop, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress. Symptoms may include pain, stiffness and limping.

Because athletically active people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise does not cause FAI.

People with FAI usually have pain in the groin area, although the pain sometimes may be more toward the outside of the hip. Sharp stabbing pain may occur with turning, twisting and squatting, but sometimes, it is just a dull ache.


Hip Arthritis

If you feel pain and stiffness in your body or have trouble moving around, you might have arthritis. Most kinds of arthritis cause pain and swelling in the joints. Over time, a swollen joint can become severely damaged. Some kinds of arthritis can also cause problems in your organs, such as your eyes or skin.

  • Osteoarthritis is the most common type of arthritis. It’s often related to aging or to an injury.
  • Autoimmune arthritis happens when your body’s immune system attacks healthy cells in your body by mistake. Rheumatoid arthritis is the most common form of this kind of arthritis. Juvenile rheumatoid arthritis is a form of the disease that happens in children.
  • Infectious arthritis is an infection that has spread from another part of the body to the joint.
  • Psoriatic arthritis affects people with psoriasis.
  • Gout is a painful type of arthritis that happens when too much uric acid builds up in the body. It often starts in the big toe.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


Hip Labral Tear

A hip labral tear involves the ring of cartilage, called the labrum, that follows the outside rim of the socket of your hip joint. The labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.

Athletes who participate in such sports as ice hockey, soccer, football, golfing and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.

Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

  • A locking, clicking or catching sensation in your hip joint
  • Pain in your hip or groin
  • Stiffness or limited range of motion in your hip joint

Source: Mayo Foundation for Medical Education and Research


Osteonecrosis

Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. The lack of blood causes the bone to break down faster than the body can make enough new bone. The bone starts to die and may break down.

You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

At first, you might not have any symptoms. As the disease gets worse, you will probably have joint pain that becomes more severe. You may not be able to bend or move the affected joint very well.

No one is sure what causes the disease. Risk factors include:

  • Long-term steroid treatment
  • Alcohol abuse
  • Joint injuries
  • Having certain diseases, including arthritis and cancer

Doctors use imaging tests and other tests to diagnose osteonecrosis. Treatments include medicines, using crutches, limiting activities that put weight on the affected joints, electrical stimulation and surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


Trochanteric Bursitis

Bursae are small, jelly-like sacs located throughout the body, including around the shoulder, elbow, hip, knee and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called tronchanteric bursitis.

The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.

Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing or squatting.

Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.

Source: American Academy of Orthopaedic Surgeons


Diagnosis

Our initial patient evaluation starts with a detailed history, physical examination, review of prior treatment records and close evaluation of relevant imaging studies, such as:

  • X-rays to help your doctor see possible damage to your hip or pelvic bones and to check the shape of the ball and socket and amount of space between these structures

  • MRI (magnetic resonance imaging) to give your physician a detailed, high-resolution image of your bones, joints and surrounding soft tissues, such as tendons and cartilage, to reveal damage, deterioration or abnormality or labral tears in the joint

  • CT (computed tomography) scan to provide a cross-sectional view of your hip and pelvic areas

  • Diagnostic injections in the hip joint or other areas around the hip (tendons, bursa, etc.) to localize painful areas for better imaging


Treatments

Ohio State’s Hip Preservation Program is about more than hip surgery; it’s about total care of your hip joint. Our goal is to help you become pain-free while regaining physical strength and good range of motion.

That’s why your doctor will create a personalized treatment plan to repair your hip joint to improve structure or function. It’s also why we take a team approach to your care. Your treatment team may include surgeons, physician assistants, physical therapists, athletic trainers, sports medicine specialists, radiologists and family practice doctors. Together, with your help, we’ll manage your care to reduce surgical downtime and get you back to being active.

Most patients with hip pain benefit from treatment to reduce friction and protect the hip joint from degeneration. Your doctor will assess your condition and recommend an appropriate and personalized treatment plan that may include:

  • Hip arthroscopy to remove and repair damaged tissue. With this procedure, your surgeon will make small incisions and insert a special instrument called an arthroscope. The arthroscope has a small camera that allows your doctor to look inside your hip joint. Most patients undergoing this surgery are 55 years of age or younger; however, your doctor will tell you if this surgery is best for your health and joint recovery. Arthroscopy does not treat arthritis or inflammatory hip problems. It is, however, an effective treatment for femoroacetabular impingement, allowing patients to return to activities more quickly.

  • Physical therapy to help you heal and regain your strength. Your doctor will prescribe physical therapy starting two to three days after surgery to help decrease inflammation and pain while protecting healing or repaired tissues. You’ll also be instructed on at-home therapy including pain-free range of motion exercises. As you heal, your physical therapist will work with you to gradually increase your range of motion and improve your strength. For your convenience, we offer on-site physical therapy with specialized physical therapists so you can see both your surgeon and your physical therapist during the same visit.

  • Total hip replacement to effectively treat hip arthritis that has not responded to conventional, nonsurgical treatment (corticosteroid injections, physical therapy, etc.). Our surgical team uses a direct anterior approach (DAA) to total hip replacement so that no muscles are cut when accessing the hip joint. With this approach, your surgeon accesses your hip joint by going between individual muscle groups. Potential benefits include shorter hospital stays and reduced recovery time.


Why Choose Ohio State?

Why choose Ohio State for hip arthroscopy?

Diagnostic Expertise: Through collaborations with researchers in the Department of Radiology at the Wright Center of Innovation, Ohio State has developed advanced imaging techniques for the hip, including cartilage-imaging sequences. Preoperatively, our patients undergo a 3D CT scan of the hip joint, creating a picture of exactly what areas of the bone need to be corrected, allowing more precise surgical management.

Surgical Expertise: We are experts at reshaping, repairing and restoring the hip joint through such surgical techniques as hip arthroscopy and direct anterior total hip replacement. In fact, our fellowship-trained hip preservation specialist is one of just a handful of surgeons in the region offering this innovative treatment option.

Research: Our Hip Preservation Division maintains a clinical outcomes database to capture pre-surgical, surgical and post-surgical data points so we can understand patient recovery and improve the future of patient care.


Clinical Trials

Current studies include:

  • Outcomes following knee continuous passive motion (CPM) device-use following arthroscopic acetabular labral repair: This is a first-of-its-kind study to determine whether the use of a CPM device after hip arthroscopic surgery improves outcomes. The study measures range of motion, self-reported pain, medication use and patient satisfaction.

  • Database for hip surgery patients: This study is designed to provide quality improvement data on patients undergoing a hip preservation surgery. The study involves collecting and comparing preoperative and postoperative clinical data on hip surgery patients, including history of hip pain, surgical procedure, joint laxity measurements and rehabilitation.

  • Functional and biomechanical adaptations of athletes with femoral acetabular impingement: This prospective case control study will help determine the effectiveness of pre-operative physical therapy with neuromuscular training in order to maximize outcomes and minimize maladaptive movement. Data collection includes non-invasive testing of trunk and lower extremity joint motion, as well as hip strength and range of motion.

  • Patient-centered markers of disease and disability in patients following arthroscopy for femoroacetabular impingement: This prospective cohort study will enroll highly active patients between the ages of 14 and 50 from the Hip Preservation Division at OSU who are at least one year post-arthroscopy for FAI. The findings of the study could improve treatment of patients with FAI, as well as others at significant risk for early onset osteoarthritis and functional disability.

Enroll in a clinical trial at The Ohio State University Wexner Medical Center.

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