Hip arthroscopy helps elite athletes return to sport
The most common procedures in the series included partial acetabular labrectomy,
labral repair.
Link
http://www.orthosupersite.com/view.asp?rID=27140
March 2008
Despite being referred late for treatment of hip pain, many
elite athletes treated at Wellington Hospital in London
successfully underwent safe, effective hip arthroscopic
procedures for a variety of hip pathologies.
Patients often returned to the same level of sport within
about 4 postoperative months, investigators said.
"Chondral flaps and ligamentum teres tears are underdiagnosed
heavily," said Vikas Khanduja, MRCS(G)-MSc, FRCS (Orth).
During the British Orthopaedic Association Annual Congress
2007 in Manchester, he presented results of a retrospective
study of 31 hip arthroscopy procedures in 27 patients (25 men, 2
women).
The investigators sought to prospectively assess the role hip
arthroscopy played in treating professional athletes who
competed at the national or international level.
Same-day surgery
Hip arthroscopy can be performed with patients in the supine
or lateral position. Khanduja and Richard N. Villar, MS, FRCS,
operated with their patients positioned laterally. The surgery,
which can take up to 2 to 3 hours, required an image
intensifier. The investigators used the McCarthy distractor and
70° arthroscopes in all cases.
All patients were discharged on the same day and underwent
about 6 to 8 weeks of supervised rehabilitation, Khanduja said.
The patients’ average age was 38 years (range, 18 to 58
years); 65% were professional football players. The rest of the
athletes were primarily cricket or tennis players.
Modified Harris hip score
Before and after surgery, patients underwent a clinical exam
and had modified Harris Hip scores determined. Most of them also
underwent MRI scans or radiographs of the hip.
"A strongly positive impingement test with a background of
appropriate history was a good indication for hip arthroscopy," Khanduja said.
Patients completed detailed questionnaires preoperatively and
postoperatively and were followed up postoperatively at 6 weeks
and 3, 6 and 12 months.
One patient underwent bilateral hip arthroscopies. Three
others needed two hip arthroscopy procedures on the same hip.
Many labral tears
All patients had a positive impingement test.
"Most of them gave a very prolonged history," with the
average time to referral being 506 days, Khanduja said. One
patient was in pain for 5 years following a hip injury before
being referred.
Twenty patients ultimately had labral tears, five patients
had chondral flaps and two patients presented with ligamentum
teres tears. Twenty patients also had chondral injuries that
were diagnosed arthroscopically. Investigators reported no
complications.
Khanduja urged orthopedic surgeons who see patients like
these to refer them early "because they are referred fairly late
and underdiagnosed. Perhaps a high index of suspicion and early
referral will lead to early intervention and a quicker return to
sport."
For more information:
-
Vikas Khanduja, MRCS(G)-MSc, FRCS(Orth), is a consultant
orthopaedic surgeon, Addenbrooke’s-Cambridge University
Hospitals NHS Trust. He can be reached at Hills Road,
Cambridge, Cambridgeshire, England CB2 0QQ;
+44-1223-245-151; e-mail:
vikaskhanduja@aol.com. He has no direct financial
interest in any product or company mentioned in this
article.
Reference:
-
Khanduja V, Villar RN. Hip arthroscopy in the elite
athlete. Presented at the British Orthopaedic
Association Annual Congress 2007. Sept. 25-28, 2007.
Manchester.
