Your Hip
The hip joint is a simple ball-in-socket structure. The ball-shaped femoral head rotates inside a cup-shaped socket called the acetabulum. Usually this joint works smoothly, with little friction or wear. The well-fitting surfaces of the femoral head and acetabulum which face each other are each lined with a layer of articular cartilage and are lubricated by a thin film of synovial fluid which reduces friction inside the normal hip to less than one tenth that of an ice cube gliding on ice. The labrum is a rim of fibrous cartilage which lines the outer edge of the acetabulum and serves to stabilise and cushion the hip joint.
Over the past ten years, our understanding of hip problems has rapidly advanced. Many young, active patients with hip pain were previously thought to not have treatable problems, and hip arthritis in young adults was previously thought to be due to bad luck or unfortunate genetics. We now know that hip pain can indicate underlying conditions and subtle structural abnormalities that are not only causing symptoms now, but can also cause hip arthritis.
Alongside the recent advancements in understanding of hip problems have come advanced surgical techniques which have dramatically improved our ability to treat these problems. Hip arthroscopy is a relatively new technique that allows hip problems such as impingement, labral tears, tendonitis, ligament problems and loose bodies to be effectively treated with minimally invasive techniques.
Hip Dysplasia
Hip dysplasia is a condition where the acetabulum (hip socket) is too shallow. This is often present from birth, however may not cause any symptoms until adolescence or early adulthood. The shallow acetabulum can cause hip pain, labral tears, and early hip arthritis.
Fortunately, hip dysplasia in adolescents and young adults can be effectively treated with a special operation called a Bernese Periactabular Osteotomy (PAO), otherwise known as a Ganz Periacetabular Osteotomy, which significantly reduces pain, improves function and prevents early arthritis in patients with hip dysplasia. This operation is technically challenging, however Dr. Boyle has undertaken extensive training in this procedure by international experts at Harvard University in the USA. Dr Boyle has undertaken extensive fellowship training in PAO surgery at Harvard University and Boston Children's Hospital, and has personally performed over 410 Bernese PAOs for patients referred from throughout New Zealand.
Hip Impingement (FAI)
Femoroacetabular impingement (FAI) is a condition in which abnormal contact occurs between the ball and socket of the hip joint during movement. It is caused by extra bone on the ball (cam impingement), the rim of the socket (pincer impingement), or both. FAI is a common cause of groin pain and reduced hip range of movement in active adults and young sportspeople, and is frequently seen in footballers, cyclists, and martial artists.
Left untreated, FAI can cause progressive damage to the hip labrum and articular cartilage, leading to early hip arthritis. Arthroscopic hip surgery to reshape the bony abnormality and repair any associated labral damage is an effective treatment for patients with symptomatic FAI who have not responded to physiotherapy.
Hip Labral Tears
The labrum is a ring of cartilage that lines the rim of the hip socket (acetabulum), acting as a seal to maintain joint fluid pressure and deepening the socket to improve stability. Labral tears are a common cause of hip and groin pain in active patients and can occur as a result of FAI, hip dysplasia, acute injury, or repetitive loading.
Symptoms typically include deep groin pain, a catching or clicking sensation in the hip, pain after prolonged sitting, and pain with pivoting or sporting activity. Treatment depends on the underlying cause — hip arthroscopy can be used to repair labral tears in patients with FAI, while patients with underlying hip dysplasia may require a periacetabular osteotomy (PAO) to address the structural cause of instability and labral injury.
When should you see a hip specialist?
You should consider a referral to a hip specialist if you experience: groin or deep hip pain in a young or active person, hip pain that has not settled with physiotherapy, a clicking or catching sensation in the hip, pain that limits sport or exercise, pain after sitting for extended periods, or reduced hip range of movement. Hip conditions are most successfully treated when addressed early — before progressive cartilage damage occurs.
To arrange a referral, ask your GP or physiotherapist to contact Dr. Boyle at Auckland Bone and Joint Surgery. Referrals can be sent via HealthLink EDI: drmboyle, or by calling 09 281 6733. Dr. Boyle consults at AUT Millennium, 17 Antares Place, Rosedale, North Shore, Auckland.
