Hip Arthroscopy Patients: What are the presenting symptoms?

A recurrent question that I am asked by patients and primary care physicians is “who is a candidate for hip arthroscopy?” I think the real question being posed is “What types of symptoms do you see in patients who benefit from arthroscopic surgery of the hip?”

This is an excellent question. Hip arthroscopy is still a relatively new technique that the vast majority of orthopedic surgeons do not perform. So, let’s answer this question.

The most common symptom that brings hip patients into the office is groin pain. In some cases, there is an inciting event. In other cases, the pain begins insidiously without trauma. Either way, patients commonly state that exercise, hip rotation, prolonged car rides, or walking on uneven ground can cause groin pain. The “groin” is essentially the area in the front of the body where the leg meets the pelvis. Think of it as the very top of the thigh.

The pain often is in the front and then commonly radiates along to the lateral (outside) aspect of the hip. As opposed to a muscle strain or bruise, this pain is commonly quite deep. It is difficult for the patient to palpate (touch) the pain. There is usually not tenderness with palpation of the muscle or skin. Pain is recreated with range of motion of the hip, particularly internal rotation. Patients state that the discomfort begins as a dull ache and can progress to severe through the front and outside aspects of the hip.

Common misdiagnoses are lumbar radiculopathy (sciatica), muscular strain of the groin, hernia, gynecologic disorders, and urologic pathology. Often, patients have seen multiple physicians and tried multiple modes of treatment before the correct diagnosis of hip pathology is recognized.

The most common causes of hip pain that I see in my practice are tears of the acetabular labrum, synovitis, iliopsoas tendinitis, and femoroacetabular impingement. Each of these problems can be effectively treated arthroscopically once the diagnosis is made.

In evaluating patients, the most important pieces of information are the clinical history and physical examination. These two elements are critical in making a diagnosis of hip pathology. Imaging studies such as x-ray and MR Arthrogram are also very helpful. Intra-articular injections of cortisone and local anesthetic are utilized for both therapeutic and diagnostic purposes.

It is my hope that this information is helpful to patients and practitioners alike who may be dealing with or treating patients with possible hip pain. Knowing what symptoms to look for is the first step! I now perform over 100 arthroscopic hip surgeries each year. Starting out with hip arthroscopy in 2009, these were many of the questions I had as well. Hopefully this is helpful in making the correct diagnosis for patients suffering with hip pain.

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