Today's News

Thursday, February 13, 1997

Hip arthroscopy may detect labral injury

Hip arthroscopy, although infrequently used as a diagnostic method, is an excellent method to evaluate acetabular labral pathology, according to scientific paper 3 which will be presented Thursday morning.

Between 1989 and 1994, 117 hip arthroscopies on 109 patients were performed, following the patients' failure to respond to a minimum of six months of conservative treatment for refractory hip pain. A review two years after the hip arthroscopies found that 58 patients had acetabular labral injuries.

In the paper, to be presented by Steven R. Wardell, MD, Paols Heights, IL. Dr. Wardell previously was at New England Bone and Joint Institute, New England Baptist Hospital, Boston, where the research was conducted. "When comparing the operative findings to the clinical presentation we found statistical correlation between symptoms of anterior inguinal pain, painful clicking episodes, giving way and transient locking with labral tears" he said.

The most reproducible statistically-correlated physical finding in the group was a positive Thomas extension test. The test involves maximal flexion of both hips to eliminate pelvic lordosis, then extension of the involved hip in neutral or external rotation to reproduce the patient's pain and clicking.

The researchers said that "despite the sophistication of current radiologic procedures, there are a number of intra-articular entities that defy diagnosis by radiologic means. To date there is no reliable radiographic procedure to diagnose injury to the acetabular labrum."

A labral injury subjected to repetitive motion and torque by the femoral head may progress and cause reciprocal changes on the adjacent articular surface of the femoral head and/or acetabulum. "Disruption of the acetabular labral 'complex' may destabilize the hip joint's ability to distribute load and lead to cartilage breakdown and premature arthritis," the authors said. "Early diagnosis and treatment of patients with symptoms suggestive of an acetabular labral tear may improve the prognosis and abate the onset of degenerative arthritis."

Hip arthroscopy as a diagnostic and therapeutic tool has been infrequently performed in the management of hip pain for several reasons. "The hip joint is less accessible than other joints due to its extensive muscular and capsular investments," the authors explained. "The femoral head is deeply recessed within the acetabulum and requires longitudinal traction for adequate visualization. The surrounding neurovascular structures can be injured with inaccurate arthroscopic portal placement. In addition, equipment specific for hip arthroscopy has been quite limited."

Although most causes of functional hip pain will dissipate with conservative treatment, there are a number of patients who demonstrate reproducible refractory hip pain of mechanical origin with equivocal or negative radiologic studies. When a patient's hip pain extends beyond six months and is not responsive to appropriate conservative means, then hip arthroscopy is of significant value as both a diagnostic and therapeutic application, the authors said.

Co-authors of the study are Joseph C. McCarthy, MD; J. Bohannon Mason, MD; Van P. Stamos, MD; and James V. Bono, MD, all of the New England Bone and Joint Institute.