Scoping Out Solutions: Utilizing Investments in Technology to Improve Outcomes for Patients with Hip Pain
October 10, 2023
When you think about sports-related injuries, knees and shoulders may come to mind first. But for many athletes – specifically those who play football, hockey, soccer or dance – issues often arise in the hip joints after years of repetitive movements. For some, joint pain is occasional and manageable. For others, problems persist – making even sitting down painful.
When joint pain is no longer manageable, orthopedic surgeons can get inside the joint to view and treat the issue with a minimally invasive procedure called arthroscopy or referred to as hip scope. While more commonly used in knees and shoulders, surgeons are also using arthroscopy to treat problems in the hips.
“We’ve seen the biggest growth in hip arthroscopy in the last 10 years because of technological improvements that allow us to do a lot more within the joint that we couldn’t do before,” said Dr. Kristyn Darmafall, a board-certified and fellowship-trained surgeon at Orthopaedic Specialists. “Because of its success, hip arthroscopy is increasing in prevalence and usage.”
Performed in an outpatient setting, hip arthroscopy gives the surgeon a look inside the hip joint using an arthroscope, including a camera, inserted into the body through small incisions, typically one to two centimeters in length. The arthroscope itself is a small tube containing the camera and a light, connected to a viewing monitor in the operating room.
For procedures, Dr. Darmafall performs at Mississippi Valley Surgery Center, the Quad Cities’ largest multi-specialty outpatient surgery center. Located at 3400 Dexter Court in Davenport, MVSC is the only facility in the area with a specialized postless traction table used to better perform hip arthroscopies.
“To do the procedure, we have to distract the joint to get inside it,” Dr. Darmafall explained. “We used to use a post between a patient’s legs during the procedure that could cause extended nerve irritation. We’ve eliminated that with this specialized postless table.”
Better diagnostics reveal the cause of pain
Hip arthroscopy is used to treat several problems, including hip impingement – a condition in which extra bone will grow inside the joint, causing impingement that leads to pain in the groin area. The impingement can eventually cause a labral tear, an injury to the soft tissue that covers the hip socket.
Doctors are seeing hip impingement in slightly younger populations, as patients are typically under the age of 50. Some people are more genetically predisposed to the condition, but it can also happen to athletes in their 20s and 30s due to activities with repetitive actions, like running or dancing. Dr. Darmafall said that for these patients, use of hip arthroscopy is increasing because of improved diagnostics.
“We’re identifying the specific hip condition much better through screening techniques that help us differentiate between hip pain and lumbar back pain,” she said. “There is a lot of crossover in the symptoms of both problems.”
One clue pointing to hip impingement is patients who complain about pain in the groin at the crease of the leg when sitting down. As it worsens, patients will say they have trouble sitting for a long period of time and will have trouble getting up and down from low chairs.
Diagnosis starts with an x-ray, where Dr. Darmafall can see if there is extra bone formation. From there, an MRI will reveal the status of the cartilage and the labrum to get the whole picture of what may be causing a patient’s pain. In 70-80 percent of cases, patients with hip impingement won’t need surgery. But for those who do, it can be addressed in an outpatient procedure performed at MVSC. The surgery takes anywhere from 90 minutes to three hours, depending on how severe the problem is.
Back up and running after hip arthroscopy
Though hip arthroscopy patients will be cleared to head home the same day after their outpatient procedure, getting back up and running is a slower process. Every surgeon’s protocol is different, but Dr. Darmafall tells her patients to use crutches for the first two weeks to protect the recovering hip and the muscles around it. While they may have surgical soreness, patients will likely notice an improvement in the pain they were having before surgery.
To assist with recovery, patients see a physical therapist for at least three months until they’re cleared for regular activity like walking the dog or biking. Athletes may need closer to four or five months before they feel comfortable going back to full intensity in their sports. The good news is – once a patient heals, the condition is unlikely to recur, and most patients don’t have to treat the second hip.
Overall, Dr. Darmafall said her patients are seeing great results.
“My two-week post-op hip arthroscopy patients came in smiling this week,” she said. “They are ecstatic with how they’re doing, and it reinforces why I do this job.”
In the future, Dr. Darmafall said she expects even more advancements in procedures targeting the hips – catching up to what’s already possible in the knees and shoulders.