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Advances in Hip Arthroscopy

Safran, Marc R. MD

Sports Medicine and Arthroscopy Review: June 2010 - Volume 18 - Issue 2 - p 55
doi: 10.1097/JSA.0b013e3181e13196
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Interest is rapidly growing with regard to nonarthritic hip problems in the athlete and active patient. More than two-thirds of all articles written on the nonarthritic hip have been published in the last decade. Along with the increased interest in this arena, there has been an explosion in the evaluation and management of nonarthritic hip problems. As a result, hip arthroscopy has become the fastest growing area of orthopedic surgery. Fueling the explosion of adoption of hip arthroscopy has been the rapid development of new hip arthroscopic technology and tools to allow for easier access and enhanced ability to treat more pathologies. Thus, this issue of Sports Medicine and Arthroscopy Review is a timely update of a rapidly evolving field to compile the current knowledge and state of the art information about hip arthroscopy techniques in the active patient population. We are fortunate to have some of North America's most pre-eminent hip arthroscopists contributing to this volume of Sports Med Arthrosc Rev.

The first article by John Clohisy and Gregory Polkowski from Washington University in St Louis reviews the current state of knowledge about Hip Biomechanics and its role in the active patient. Hal Martin and associates from Oklahoma City write about the evaluation of the person with hip pain, an area of particular interest of Dr Martin's for over a decade. Marc Philippon and his associates from Vail, Colorado, outline the arthroscopic management of labral pathology, the most commonly treated pathology of the hip. This labral review includes debridement, techniques of repair, and of labral reconstruction, which Dr Philippon developed. Next, Dr Mininder Kocher and Yi-Meng Yen from Boston Children's Hospital review the arthroscopic management of chondral injuries of the hip. Debridement/chondroplasty, microfracture, and even repair of chondral flaps are discussed.

The next 2 articles discuss the management of femoroacetabular impingement in the athlete. This is an increasing commonly diagnosed problem in athletes, originally described by Ganz and colleagues in Switzerland, felt to be a major cause of hip pain in athletes, resulting in a consistent pattern of articular pathology, including labral tears and chondral injury. My paper written with my fellow, Zackary Vaughn, discusses the management of the femoral-sided (Cam) lesions, due to loss of femoral head-neck offset and asphericity of the femoral head. Chris Larson from Minnesota discusses the management of the acetabular-based lesions resulting in pincer impingement. Most patients, however, have a combination of these 2 types of impingement, and Dr Larson does demonstrate some cases of combined type femoroacetabular impingement.

Jon Sekiya and Matthew Smith from the University of Michigan review an increasingly recognized problem, hip instability. Drs Sekiya and Smith discuss the management of traumatic hip dislocations, and the arthroscopic management of more subtle forms of instability.

The next 2 articles review periarticular hip problems, frequently seen in the athletic individual, and are treated with the scope. Bryan Kelly, from the Hospital for Special Surgery in New York, with Shane Nho and Eric Strauss from Rush Medical College in Chicago, review the Greater Trochanteric Pain Syndrome and its arthroscopic/endoscopic management, an area Dr Kelly has been a trailblazer. The Greater Trochanteric Pain Syndrome includes trochanteric bursitis, external snapping hip, and hip abductor avulsions. Victor Ilizaliturri and Javier Camacho-Galindo from the National Rehabilitation Institute in Mexico City conclude this volume with the endoscopic/arthroscopic management of the snapping hip. Dr Ilizaliturri developed the endoscopic technique for management of the external snapping hip, and completed and published the only prospective randomized study of different techniques for the endoscopic management of the internal snapping hip.

Great effort and care have been put forth by the authors in compiling this edition of Sports Med Arthrosc Rev, as there continues to be a paucity of literature regarding hip injuries in athletes, and this field is rapidly expanding. Fortunately, many of the leaders in this field have contributed to this edition of Sports Med Arthrosc Rev, resulting in the most up-to-date information about the state of the art in hip arthroscopy in the athlete. The end result is what I, and the contributing authors, would hope to be the most current and comprehensive view of arthroscopic management of hip problems in the patients with nonarthritic hip pain.

It is hoped that this edition of Sports Med Arthrosc Rev will provide you with the information to perform some of these techniques to help your patients.

© 2010 Lippincott Williams & Wilkins, Inc.