Hip arthroscopy: Focus on underlying abnormalities

Dec. 22, 2018

Mayo Clinic takes a comprehensive approach to hip arthroscopy, going beyond repairing the labral tear to addressing the underlying abnormalities. "Our approach is evidence-based. It's generally the underlying bony abnormalities that drive the process of labral tears, and we're very focused on trying to correct those problems," says Matthew M. Crowe, M.D., an orthopedic surgeon at Mayo Clinic in Jacksonville, Florida. "Although these surgeries certainly aren't a cure-all for every young patient with hip pain or hip problems, we're finding that many patients are very good candidates for these procedures and benefit from them."

Across Mayo Clinic's three campuses, orthopedic surgeons perform hip arthroscopy in patients whose ages range from adolescence through their 60s. Mayo's comprehensive approach begins with diagnosis. "It's generally carried out in a multidisciplinary fashion, with a lot of help from our nonoperative sports medicine providers and our imaging experts," Dr. Crowe says.

As a multidisciplinary practice, Mayo Clinic facilitates collaboration among specialists. "An MRI with contrast in the hip joint is a very nuanced image that requires expertise to analyze. I routinely walk down the hallway to review patient images with our fellowship-trained musculoskeletal radiologists," Dr. Crowe says.

Diagnostic procedures often indicate that the patient will respond well to nonoperative treatments, including focused physical therapy or injection procedures. If surgery is indicated, Mayo Clinic offers both open and arthroscopic hip preservation options.

"A lot of people have unrecognized hip dysplasia or other chronic developmental abnormalities that aren't optimally treated with arthroscopy. But these patients can benefit from other hip procedures," Dr. Crowe says. "We are increasingly improving our understanding of which patients benefit from which procedures."

After surgery, Mayo Clinic has specific protocols for rehabilitation, which patients can follow with their local providers. Dr. Crowe, who had hip arthroscopy at Mayo Clinic's campus in Minnesota, has followed the protocol. "I have experience with this protocol as both a surgeon and a patient. This rehabilitation is a very important part of treatment," he says.

Surgical hamstring repair

Hamstring injuries, which tend to occur in active people between the ages of 40 and 70, have generally been treated nonoperatively. Due to the persistent pain experienced by some patients, Mayo Clinic has begun treating more of these injuries surgically.

"On closer inspection, we're now seeing that a lot of patients treated nonoperatively 10 or 15 years ago aren't happy with the long-term outcomes. They experience weakness in the injured leg and aren't able to resume their normal activities. As a result, we've started considering surgery for more of these patients," Dr. Crowe says.

"Unlike most injuries in younger athletes, which are often located where the muscle and tendon meet and can be treated nonoperatively, many of our older athletes and patients who have complete or partial hamstring tears can experience a lot of pain and difficulty with sitting, if they're treated nonoperatively," he says. "For those patients we now have good surgical options."

Dr. Crowe notes that not everyone who has hip arthroscopy or hamstring surgery will be completely pain-free. "But the vast majority of patients have significant improvement from these surgeries and are able to return to doing what they like," he says. "Overall, the improvement in people's quality of life is significant."