Differences in hip arthroscopy attitude

[injuryupdate]

Just read the article below from Herald-Sun, and being based in Sydney, I was surprised. Amongst Sydney surgeons, hip arthroscopy is still viewed as a procedure of last resort. I understand the stats are that 8 times as many hip scopes are done in Melbourne, but it is a lot more aggressive to hear of a teenager getting an operation 'to make sure it doesn't flare up later'. I appreciate we do this with knees in an off-season for professionals.

Hip op recovery on song
23 October 2006 Herald-Sun
David Hastie

TOP Victorian draft hope Lachlan Hansen says his recovery from hip surgery this month is ahead of schedule.

The key defender had surgery to repair cartilage after completing the national draft camp at the AIS in Canberra.

The surgery has not quelled interest in the 196cm defender, with Carlton believed to be weighing up securing the youngster with the No. 1 pick.

"It (the hip) has pulled up pretty well actually," Hansen said.

"I was supposed to be on crutches for a bit, but I wasn't on crutches or anything. I'm walking around pretty good.

"I fell on it at the start of the year and it just kept getting worse and worse, so I just had to get it cleaned up."

Despite carrying the injury into the draft camp, the under-18 All-Australian centre half-back said the hip injury had hindered him only during the agility test.

"I wasn't really sure if I needed to have it (surgery) done," Hansen said.

"But they just thought it would be best to have it done so I would be prime once the pre-season comes around."

[Hipster]

You're definitely not the only one who was intrigued by this article. I suppose, as you say, they are using similar reasoning for arthroscopy of the hip joint which they would normally use for fixing cartilage damage in the knee. However my problem with this reasoning is that we have minimal to zero evidence of this being effective in improving hip symptoms in the athlete population. This is mainly due to the fact that no research has been funded to do a long term trial based on functional outcomes. Of course this doesn't mean that we shouldn't do the surgery, it just means that we have to be wary of jumping to conclusions.

From my clinical experience, the value of surgery for this young fellow will depend on the underlying primary pathology. Was his cartilage damage caused by extrinsic factors affecting an otherwise normal hip? If so, after a clean up and rehab he should have a relatively good outcome. If on the other hand the cartilage damage is secondary to intrinsic pathology? - ie hip dysplasia he may have a less favourable outcome.

Fingers crossed for Mr Hansen (I hope he had a good, experienced hip surgeon)- and with any luck with the passage of time, we will have more evidence for the use of hip arthroscopic proecedures as both a short term and long term management tool. I'm seriously thinking about doing the research myself so if anyone has any good ideas on the best or most clincally useful way to approach such an undertaking- drop me a line.

Hipster:cool: