Groin or hip pain may appear in young athletic adults during certain flexion movements. This most often corresponds to an “acetabular impingement syndrome” which must be treated by arthroscopy provided that it progresses to osteoarthritis.
According to a new study published in The Lancet, inguinal hip pain in people over 16 years of age related to acetabular impingement, can be advantageously treated by arthroscopy aimed at correcting the bone abnormalities at the origin of the impingement.
According to this controlled study of 348 patients and 12 months, adults over 16 years of age with hip pain on exertion related to acetabular impingement benefit more from arthroscopy than from specialized hip rehabilitation.
A conflict between the pelvis and the femur
Acetabular impingement is a “bone-to-bone” impingement that usually occurs in flexion and internal rotation of the hip, between the anterior rim of the pelvic joint and the neck of the femur. This conflict occurs in young athletes who make efforts in flexion and internal rotation of the hip: rowing, dance, martial arts, but also football or rugby.
It is linked to abnormalities of the pelvis with joint covering too much, or of the femoral neck, which lead to a bone impingement during flexion internal rotation of the hip (the neck of the femur comes up against the antero-superior edge of the joint of the hip, the “acetabulum”).
An unknown diagnosis
The acetabular impingement is still a new concept which is linked to the fact that doctors and surgeons apprehended the functioning of the hip in a static way, whereas it is a purely dynamic impingement since it only appears in a position of flexion-internal rotation of the hip. However, this is absolutely not the usual position for carrying out x-rays of the hip bones.
The key examination is arthro-MRI, or arthrography, with 3D reconstructions, because it allows both to visualize the anomaly at the origin of the bone conflict and to evaluate the impact of this conflict on the bones. articular structures (cartilage and glenoid pad).
A long vague treatment
Arthroscopy demonstrates in this good quality study its interest in young adults suffering from persistent and disabling acetabular impingement when they do not have osteoarthritis.
At 12 months, the functional result is superior to specialized hip rehabilitation. This is the first comparative study carried out in this disease, the surgeons relying so far on their experience to recommend this technique, which is much less invasive and “stiffening” for the joint than conventional surgery.
Hips #arthroscopy versus best conservative care for the treatment of #femoroacetabular impingement syndrome (#UKFASHION): a multicenter randomized controlled trialhttps://t.co/6XVPUla3ba pic.twitter.com/Oe3sHs2TVZ
— The Lancet (@TheLancet) June 4, 2018
A follow-up to be organized
It remains to be verified on a longer-term follow-up study that the joint does not progress to hip osteoarthritis in the longer term. In any event, the alternative would be the placement of a prosthesis, which should be avoided in young adults and this technique would still save time. It should be noted that rehabilitation is not without effectiveness in this study and that it can therefore be used initially, in particular in minor forms.
However, in the case of early osteoarthritis, with deterioration of the cartilage or osteophyte (“parrot’s beak”), it has not been proven that arthroscopy can prevent the patient from improving in the long term and from prevent progression to advanced hip osteoarthritis.
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