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Dr. Hyman's Hip Arthroscopy Blog

High-profile patients like New York Yankees slugger Alex Rodriguez and world-class sprinter Tyson Gay have helped hip impingement procedures acquire a certain cachet, but some surgeons say more evidence and long-term patient monitoring is needed to determine the bone-shaving surgery’s true usefulness.

The idea behind the combination surgery is this: A hip bone with irregularly shaped rough edges rubs against soft tissue in the joint, causing tendons to fray or muscles to tear. By shaving and smoothing the bone, surgeons hope to protect patients from further injury and prevent the development of arthritis in the hip. The amount of bone that is removed varies, but can sometimes be as much as one-third of the top

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Read the full article here.


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learn more about surgery for impingement and hip arthroscopy, see my website at www.hiparthroscopydoctor.com

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.

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An article has been released regarding the literature and personal experience, which identifies a variety of factors that can lead to unsatisfactory results after hip arthroscopy, as follows:

1) Failure to repair labral lesions
2) Progression of chondral damage
3) Failure to correct the bony alteration causing FAI:
a. Insufficient correction
b. Overcorrection leading to instability or fracture
4) Hip arthroscopy in the setting of radiographically advanced osteoarthritis
5) Complications related to the surgical technique
6) Poor patient’s selection

The full article may be read here.

For more information on hip arthroscopy, please see my website at www.hiparthroscopydoctor.com

Please be advised, we

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do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.

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A study was published recently discussing the risks of fluoroscopic radiation exposure during hip arthroscopy for pregnant women. It reached the conclusion that fluoroscopy used in hip arthroscopy generates a maximal theoretical dose of 2.99 mGy to the fetus, which places the procedure in the low-risk category.

This study partially addresses concerns of pregnancy and radiation exposure during hip arthroscopy. A patient may seek consultation with her Ob-Gyn physician if there is particular concern.

The study can be viewed here.

For more information on

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hip arthroscopy, please see our website at www.hiparthroscopydoctor.com

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.

Tagged with:

A recently published article outlines the risks for VTE (venous thromboembolism) associated with oral contraceptives in conjunction with hip arthroscopy. Here is an abstract of the article, and the link for the full article is below:

Oral contraceptive use cited as a risk factor of VTE after hip arthroscopy
In a recently presented study, researchers reported a low risk of venous thromboembolism following hip arthroscopy and identified oral contraceptive use and family history as risk factors for the this complication.

“There is a low rate of venous thromboembolism [VTE] postoperatively from hip arthroscopy in our series, 1.4%,” Roy I. Davidovitch, MD, said during his presentation. “We did not detect asymptomatic venous thromboembolism, with 58% of the patients undergoing an ultrasound. The [deep vein thrombosis] DVTs that were detected were symptomatic. We think that oral contraceptives are likely the most common risk factor in this patient population.”

Retrospective study

To determine the rate of VTE and DVT after hip arthroscopy, Davidovitch and colleagues conducted a retrospective study of 144 patients. They excluded five patients from the study

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who were either younger than 18 years or received postoperative

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prophylaxis. Patients included in the review had an average age of 37 years and a mean body mass index (BMI) of 25. Sixty-one percent of the patients were women.

Here is the full article.

To find out more about hip arthroscopy, please see my website at www.hiparthroscopydoctor.com

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.


A recent study in our peer-reviewed literature of the Journal of Bone and Joint Surgery had some interesting assertions: the authors of the study suggested that when Arthroscopy is done in a lateral decubitus position, the weight or pressure of attraction may be more significant in nerve injury parentheses sciatic nerve and parentheses then when done in a supine position. In the supine position the duration of time in traction maybe more important than the weight or pressure of traction in causing nerve injury parentheses who dental nerve end of parentheses. The sciatic nerve was more commonly injured in the lateral position in the pudendal nerve was more commonly injured in the supine position. It was not established whether the sciatic nerve injury was due to possible aberrant portal placement or simply due to the effects of traction.

You can see this link for further details on the original study. It is also attached.

For more information on hip arthroscopy, see my website at www.hiparthroscopydoctor.com.

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person,

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A recent study was published regarding the risk of sciatic nerve traction injury in the Journal of Bone and

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Joint Surgery:

Risk of Sciatic Nerve Traction Injury During Hip Arthroscopy—Is It the Amount or Duration?: An Intraoperative Nerve Monitoring Study

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Using intraoperative nerve monitoring we prospectively studied the prevalence, pattern, and predisposing factors for sciatic nerve traction injury during hip arthroscopy.


Of sixty patients (thirty-one female and twenty-nine male, with a mean age of thirty-seven years [range, sixteen to

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sixty-one years]), thirty-five (58%) had intraoperative nerve dysfunction and four (7%) sustained a clinical nerve injury. The average maximum traction weight (and standard deviation)

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for patients who did and those who did not have nerve dysfunction or injury was 38.1 ± 7.8 kg (range, 22.7 to 56.7 kg) and 32.9 ± 7.9 kg (range, 22.7 to 45.4 kg), respectively. The odds of a nerve event increased

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4% with every 0.45-kg (1-lb) increase in the traction amount (age/sex-adjusted; p = 0.043; odds ratio, 1.04; 95% confidence interval, 1.01 to 1.08). The average total traction time for patients who did and those who did not have nerve dysfunction was 95.9 ± 41.9 minutes (range, forty-two to 240 minutes) and 82.3 ± 35.4 minutes (range, thirty-eight to 160 minutes), respectively, and an increase in traction time did not increase the odds of a nerve event (p = 0.201). Age and sex were not significant risk factors.

Read the study here: jbjs.org/article.aspx?articleid=1375179

To find more information about Hip Arthroscopy, see our website at www.HipArthroscopyDoctor.com

Please be advised, we do not have established

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patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.

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Presented at the interim meeting of the AOSSM, San Francisco, California, February 2012.

Background: The prevalence of abnormal magnetic resonance imaging (MRI) find-ings in an asymptomatic population has yet to be determined.

Purpose: The purpose of this study was to assess a cohort of asymptomatic people to determine the prevalence of hip lesions.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Forty-five volunteers with no history of hip pain, symptoms, injury, or surgery were recruited for enrollment in this institutional review board–approved study. The subjects underwent a unilateral MRI scan with a Siemens 3.0-tesla scanner. The extremity side evaluated by MRI was alternated. All MRI scans were reviewed by 3 fellowship-trained musculoskeletal radiologists. The scans were mixed randomly with 19 scans from symptomatic patients to blind the radiologists to the possibility of patient symptoms. An abnormal finding was considered positive when 2 of 3 radiologists agreed on its presence.

Results: The average age of volunteers was 37.8 years (range, 15-66 y); 60% were men. Labral tears were identified in 69% of hips, chondral defects in 24%, ligamentum teres tears in 2.2%, labral/paralabral cysts in 13%, acetabular bone edema in 11%, fibrocystic changes of the head/neck junction in 22%, rim fractures in 11%, subchondral cysts in 16%, and osseous bumps in 20%.

Participants older than 35 years were 13.7 times (95% CI, 2.4-80 times) more likely to have a chondral

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defect and 16.7 times (95% CI, 1.8-158 times) more likely to have a subchondral cyst compared with participants 35 or younger. No other joint lesions were associated with age. Male subjects were 8.5 times (95% CI, 1.2-56 times) more likely to have an osseous bump than female subjects. No other joint lesions were associated with sex.

Conclusion: Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears

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being identified in 69% of the joints. A strong correlation was seen between participant age and early markers of cartilage degeneration such as cartilage defects and subchondral cysts.

For more information on hip arthroscopy and relevant conditions, see our website at www.hiparthroscopydoctor.com

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.

Hip Microfracture Question

On October 29, 2012, in Conditions, Precautions, Surgery FAQ's, by JonHyman

An active, healthy 60 year old woman who has exercised regularly her entire life and is 5ft.8in, 130 pounds has submitted this question:
In July I developed sudden right hip pain unrelated to an injury or accident. I have a history of cartilage delamination in both shoulders and have a hemicap on the left and a total shoulder replacement on the right. No explanation has ever been found for the delamination. With this history my doctor decided to do a diagnostic hip arthroscopy and found the same type of delamination of the acetabulum. There were no arthritic changes in the joint and he said the

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femur looked like that of a sixteen year old. So he did microfracturing of the lesion in the hip. My question for you is do you think that since I seem to have some defect in my cartilage is it likely that the cartilage will regenerate in my hip? Have you seen successful microfracturing in someone as old as me? If it is unlikely to work I don’t want to go through the 6-8 weeks of no weight-bearing.”

Hard to say, microfracture techniques are less predictable in the hip because of the concavity of the socket and the usual superior (12 o’clock) position of most defects. The force fom the femoral head often digs into the defect and can make healing a challenge. IF your bone had good bleeding and IF your defect was well bordered by healthy cartilage and IF the defect was not very large, you have a reasonable chance of healing it, even at 60.

For more information, see my website at www.hiparthroscopydoctor.com.

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to

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Tyson Gay, world champion 100 and 200 meter runner and the second-fastest man in history, has returned to the Olympics following a near career-ending injury in 2011.

After failing to qualify for the 100m final in the 2008 Beijing Olympics,

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Gay rebounded to beat Usain Bolt in Shanghai 2009 with a time of 9.69 seconds for the 100m, tying Bolt’s record. But in 2011, tragedy struck at the national trials when he had to pull out of the semi-finals of the US World Team due to an injured hip.

His focus changed to healing his hip, and on July 7, 2011, Tyson Gay underwent hip arthroscopy, labral repair, and procedures for impingement. Several months of intense rehab and rest from running followed until he was

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given the clear to begin training again on November 15, 2011.

Fast forward just 8 months, and Tyson Gay was back in the Olympics and favored to medal against the Jamaican’s Usain Bolt and Yohan Blake in the 100m finals. Running an incredible race of 9.8 seconds, Tyson Gay placed 4th, a hundredth of a second separating him from Olympic glory.

He will have one more chance to medal when he joins the men’s 4×100 meter Relay Team in their

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quest for Olympic Gold.

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.


Inversion Tables for Hip Pain?

On July 11, 2012, in Pain FAQ's, by JonHyman

We’ve had several inquiries as to whether or not inversion tables have any benefit for alleviating hip pain.

There are no scholarly studies published that have investigated the effectiveness of these tables, or similar devices. The only information readily available on them is from the manufacturers of the products.


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said, there are many testimonials from people who state that when done regularly, inversion tables provide relief from back pain, and increase flexibility and range of motion. What works for one person may not work for another.

What are your experiences with inversion tables?

Please be advised, we do not have established patient/physician relationship for medical care. If you need medical care or medical

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