Hip-Joint and Femoral Osteoplasty

Hip joint pain has received a lot of attention during the past decade. What was often attributed to a hip strain or groin pull is now better understood, along with its distinct causes of discomfort. Especially in young athletes, several different causes of hip-joint pain are being diagnosed and treated.

One cause of hip-joint pain is called femoroacetabular impingement (FAI). This condition is characterized by abnormal bone shapes of the ball (femoral head) or socket (acetabulum), which may be risk factors for early hip joint arthritis. One of the treatments for FAI is to re-contour the bone shape, a procedure called an osteoplasty.

Hip Joint Lesions

The hip joint is a ball-and-socket joint, and abnormal bone shapes can occur on either the ball or the socket of the hip. These are called cam or pincer lesions of the hip.

• Cam lesion: of the ball bumps into the socket when the hip is flexed (bent up) or rotated (turned). In FAI, a cam lesion refers to an abnormal shape of the ball (head of the femur), where the femoral head meets the femoral neck. X-rays may show that the ball is not as round as normal, and this prominent area can bump into the socket when the hip is flexed (knees bent toward the chest) or rotated up and inward.
• Pincer lesion: A pincer lesion occurs when there is excess bone at the rim of the socket, which also limits the amount the hip can freely flex.

Some people diagnosed with FAI have both cam and pincer lesions, while others have one or the other. Many patients with FAI also have labral tears of the hip.

Treatment Options

Most patients diagnosed with FAI will start with trying simple treatments first. If the misshapen bony areas are seen on X-ray, but are not causing symptoms of hip pain, typically no treatment is needed. If the pain is a problem, treatment includes rest, physical therapy, and anti-inflammatory medications.

If conservative treatments does not provide adequate relief, a surgical procedure to reshape the bone, called an osteoplasty, might be considered. There are two surgical approaches to performing an osteoplasty.

• Hip arthroscopy: Arthroscopic hip surgery is becoming more common, and reshaping the bone can be performed arthroscopically. The advantages of performing an osteoplasty arthroscopically are that it is a minimally invasive surgery, and it allows the surgeon to inspect the hip-joint cartilage. The disadvantage is the procedure can be technically difficult, and it may be more difficult to ensure adequate removal of the bony areas.
• Open osteoplasty: Another option is to make an incision over the front of the hip and reshape the bone under direct visualization. The advantage to this method is that your surgeon can often be more aggressive. The disadvantage is that it is a more invasive surgery. 

In both cases, additional procedures to address cartilage or labrum tears of the hip joint may be performed at the same time.

Does Osteoplasty Prevent Arthritis?

This is a question of great debate. Although this procedure can reduce pain from FAI, there has been no long-term study to demonstrate that reshaping bone around the hip joint will help to slow the progression of arthritis. Osteoplasty is often performed in combination with other procedures in the hip to address the labrum. Studies are ongoing to determine the long-term benefits of procedures used to treat FAI.