2023-12-04 09:56:26
by Cesare Faldini
If the damage to the cartilage has not yet begun, it is possible to correct the anomalies with a minimally invasive hip reshaping operation to protect the joint from an early arthritic evolution
I am 24 years old and have been suffering from pain in the groin and right buttock for two years. An orthopedist diagnosed me with cam and pincer anomalies, a second specialist prescribed physiotherapy sessions and hyaluronic acid infiltrations. The pain decreased slightly, but not disappeared. What do you recommend?
Cesare Faldini, full professor of Orthopedics and traumatology, University of Bologna, responds; director of the Department of Complex Orthopedic – Traumatological Pathologies; director of Orthopedic and Traumatology Clinic I, Rizzoli Orthopedic Institute, Bologna (GO TO THE FORUM)
The hip is an extremely mobile joint thanks to the spherical head of the femur, which rotates inside the acetabular cavity. The cam anomaly concerns the shape of the neck of the femur, which is too wide, which comes into conflict with the acetabulum, while in the pincer the external part of the acetabulum is narrowed and pinches the neck. Both conditions give rise to femoroacetabular impingement, typical of young people. The initial symptoms consist of pain in the groin or buttock that intensifies with sporting gestures or efforts, triggered by extreme joint movements, such as squatting or rotating the limb internally. It is very important not to neglect the pain: an accurate clinical evaluation and a nuclear magnetic resonance imaging of the pelvis can highlight the femoroacetabular conflict early.
Minimally invasive surgery
If the damage to the cartilage has not yet begun, it is possible to correct the cam or pincer with a minimally invasive hip reshaping operation to protect the joint from an early arthritic evolution. The operation requires approximately two days of hospitalization and a joint rest period of approximately 4-6 weeks, using crutches. Recovery is generally complete and also allows you to return to sporting activity. If femoroacetabular conflict is not diagnosed early, it leads to the appearance of arthrosis: the cartilage lining the femoral head and the acetabular cavity is ruined. In the initial phase, body weight control, low impact sports and possible cycles of infiltration with hyaluronic acid can keep the pain under control.
Prosthetic replacement
If the arthrosis is very advanced, the resolution of the conflict does not reduce the pain: in this case the x-ray shows a narrowing of the joint space and, if the symptoms are disabling, it is necessary to resort to prosthetic hip replacement, which today can also be performed in young patients with excellent long-term results. The anterior technique, without detaching muscles, allows for very early recovery without loss of strength, while the use of prostheses made of highly biocompatible materials with ceramic components also allows recovery from sporting activity. The Italian register of RIPO orthopedic prostheses, born from a project of the Rizzoli Institute in Bologna, studies the long-term survival of implants: prostheses implanted 20 years ago, recalled for inspection, are still working without signs of wear in 92% of cases. For this reason they can also be offered to very young patients.
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December 4, 2023 (modified December 4, 2023 | 08:56)
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