Hip-Joint and Femoral Osteoplasty

Doctor examining the hip of a patient during an appointment

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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 often thought to be an early precursor to hip-joint arthritis and is characterized by the formation of bone spurs that surround the ball and socket hip joint. One of the treatments for FAI is to remove the bone spurs that surround the hip joint, a procedure called an osteoplasty.

Hip-Joint Bone Spurs

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

  • Cam lesion: A cam lesion occurs when the bone spur is on the ball of the hip joint, the top of the thigh bone. X-rays of a patient with a cam lesion show a ball (the femoral head) that doesn't look as round as normal, with a bump on the side of the ball. This part of the ball bumps into the socket when the hip is flexed (bent up) or rotated (turned).
  • Pincer lesion: A pincer lesion is a bone spur that extends out from the socket of the hip joint (the acetabulum). A pincer lesion prevents the ball from moving as freely.

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 bone spurs 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.

Patients may find stretching the hip joint increases discomfort, since the bone spurs cannot be "loosened up" by stretching.

If simple treatments don't provide adequate relief, a surgical procedure to remove the bone spurs, 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 the removal of bone spurs 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 bone spurs.
  • Open osteoplasty: Another option is to make an incision over the front of the hip and remove the bone spurs under direct visualization. The advantage to this method is that your surgeon can often be more aggressive in ensuring the bone spurs are removed. The disadvantage is that it is a more invasive surgery. An open osteoplasty is typically performed via the same incision used for the popular anterior hip replacement.

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 removing bone spurs 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.

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Article Sources
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  1. American Academy of Orthopaedic Surgeons. Femoroacetabular Impingement. Reviewed November 2016

  2. Viswanath A, Khanduja V. Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?. J Hip Preserv Surg. 2017;4(1):3-8. doi:+10.1093/jhps/hnw050

Additional Reading
  • Nepple JJ, et al. "Overview of Treatment Options, Clinical Results, and Controversies in the Management of Femoroacetabular Impingement" J Am Acad Orthop Surg July 2013 vol. 21 no. suppl S53-S58.