Forging Advances in Femoroacetabular Impingement Treatment
Hip arthroscopy has found its rightful place in the orthopedic surgery domain for treating injuries to the hip while preserving the anatomy and function of the hip joint.
Under the direction of T. Sean Lynch, MD, the Center for Athletic Hip Injuries and Hip Preservation at Columbia University Irving Medical Center, orthopedic surgeons are evaluating a number of avenues to optimize the care of patients with athletic and other hip injuries. Of particular interest is triaging these patients to the appropriate level of care – from physical therapy and injections to hip arthroscopy. To that end, Dr. Lynch and his colleagues have streamlined protocols for managing patients with hip injuries, which tend to be multidisciplinary conditions requiring the collaborative and coordinated expertise of orthopedic surgeons, musculoskeletal radiologists, nonoperative physicians, and physical therapists.
While our orthopedic physicians manage the many acute injuries that can occur around the hip, such as muscle injuries typically seen in weekend warriors, the care of patients with chronic hip injuries in the setting of femoroacetabular impingement are particularly concerning because pinpointing the origin of the pain is puzzling and not generally linked to a traumatic event. As a result, it can be difficult to isolate a diagnosis, especially when the hip pain may originate from intra- and extra-articular hip structures, the lumbar spine, the pelvic floor, or a combination of these, or be referred as pain from the bowel, bladder, or reproductive organs.
Establishing Best Practice Guidelines
A systematic review and meta-analysis led by Dr. Lynch in collaboration with thought leaders in hip arthroscopy from across the country has resulted in the establishment of best practice guidelines for the surgical and nonsurgical management of patients with femoroacetabular impingement. The comprehensive tool provides a checklist that can help sports medicine providers, orthopedic surgeons, athletic trainers, and physical therapists provide optimal and safe care for patients with these athletic hip conditions. Through a validated consensus process – the Delphi method – the team of experts reached consensus on 27 preoperative recommendations, 15 interoperative practices, and 10 postoperative protocols in the final guidelines. The development of these first-ever national consensus-based best practice guidelines for the surgical and nonsurgical management of FAI is discussed in an article published in the January 15, 2020, issue of the Journal of the American Academy of Orthopaedic Surgeons.
Ultrasound-Guided Hip Injections
A recent article by Columbia orthopedic surgeons and sports medicine physicians published in the May 15, 2019, issue of the Journal of the American Academy of Orthopaedic Surgeons highlights the diagnostic and therapeutic value of ultrasonography-guided hip injections for an orthopedic practice. The authors note, “The proximity of the hip to important neurovascular structures, lack of palpable anatomic landmarks, and deep location of targets can make use of ultrasonography-guided injections ideal.”
Hip injections are playing an increasingly important role in both the diagnostic and nonsurgical treatment practices for hip pain. Ultrasonography enables physicians to view the hip anatomy in real time, and the patient’s response to the injection can help guide selection for surgery and allow for better pain control of the soft tissue pathology that often accompanies intra-articular pathology.
Biomarkers for Early Recognition
Are there specific biomarkers available to facilitate early detection and management of patients with hip conditions, including femoroacetabular impingement (FAI) and osteoarthritis (OA)? That is the question Columbia orthopedic faculty sought to answer in a review of more than 1,700 patients across three centers. The researchers assessed 43 unique biomarkers, finding a significant difference in levels of the fibronectin-aggrecan complex (FAC) in patients with OA compared with controls. In the setting of femoroacetabular impingement, cartilage oligomeric matrix protein (COMP) was significantly increased in athletes after adjusting for concurrent knee and hip OA. Their findings published in the November 2018 issue of The American Journal of Sports Medicine, suggest that because both FAC and COMP were able to differentiate between controls and patients with hip lesions, these biomarkers have the potential to aid in diagnosis and management of FAI and hip OA.