Update: A leading cause of hip surgery? MRI
In the most recent research, radiologists declare that MRI for the detection of cartilage damage is – at best – fair.1 These finding again confirm the problems of basing a surgical treatment on an MRI finding for hip pain.
People with no hip pain have a lot of problems, according to the MRI
Researchers took forty-five volunteers with no history of hip pain, symptoms, injury, or surgery for recruitment into their institutional review board-approved study. The subjects underwent a MRI scan, which was 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. The average age of volunteers was 37.8 years (range, 15-66 y); 60% were men.
Here are the problems they saw:
- 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%
- Osseous bumps in 20%
Participants older than 35 years were 13.7 times more likely to have a chondral defect and 16.7 times more likely to have a subchondral cyst compared with participants 35 or younger.
Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints.2
In February 2012, research was presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day meeting that suggested that when doctors treat people with hip pain, “physicians should not replace clinical observation with the use of magnetic resonance images (MRI).” The research stated that when MRIs were performed on volunteers WITHOUT hip pain – 73% showed abnormal finds.3
Dr. Merson does not rely on MRI results alone to determine a treatment plan. A skilled physician can make a more accurate determination of an injury and treatment plan with a careful physical examination and history. There is a certain appeal to the patient to get an MRI, especially the athlete who thinks it is part of the normal process of treatment. It is sometimes difficult to get the patient to understand that when they get an MRI there will be a recommendation for a surgery that is often unnecessary.
Hip resurfacing surgery alternatives
Surgery should always be the last option for a pain or sports injury, as once surgery is performed, you can never go back.
Despite doubts to its success, many athletes are turning to hip resurfacing or bone shaving as a means to treat Hip impingement syndrome or femoro-acetabular impingement (FAI) syndrome. Hip pain occurs in athletes when the bone develops “spurs” or rough edges. These abnormalities begin to rub and fray against the ligaments, tendons and other soft tissues of the hips. Pain and weakness ensues and osteoarthritis develops in the long run.
Why are young athletes turning to this procedure?
The belief is that they can run again without complication. However, “Running is possible after hip resurfacing, and runners can even return to some level of competition, but this short follow-up series of hip resurfacing in athletes should be interpreted with caution regarding implant survival.”4
Where is the evidence that shaving bone helps?
Recently, the New York Times reported that “sports medicine researchers are asking: where is the evidence that shaving bone helps?”
“The idea is that bone that has rough edges or an irregular shape in the hip is rubbing against soft tissue in the joint, causing tendons to fray or muscles to tear. The hope is that by shaving and smoothing the bone, surgeons can protect patients from further injury and also protect them from developing arthritis. The amount of bone removed varies but can be significant — sometimes, as much as a third of the thigh bone’s top.
One difficulty in assessing the operation’s effects is that it is combined with other procedures to repair torn tissue. When patients say they feel better, is that because their impingement was fixed or because their torn tissue was repaired, or both?”5 Prolotherapy and PRP can address the underlying cause of hip pain and bone spurs.
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1. Xu L, Hayashi D, Guermazi A, Hunter DJ, Li L, Winterstein A, Bohndorf K, Roemer FW. The diagnostic performance of radiography for detection of osteoarthritis-associated features compared with MRI in hip joints with chronic pain. Skeletal Radiol. 2013 Oct;42(10):1421-8. doi: 10.1007/s00256-013-1675-7. Epub 2013 Jul 11.
2. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. Am J Sports Med. 2012 Oct 25. [Epub ahead of print]
3. Treatment for Hip Conditions Should Not Rest Solely on MRI Scans. AOSSM February 11, 2012.
4. Fouilleron N, Wavreille G, Endjah N, et al. Running Activity After Hip Resurfacing Arthroplasty: A Prospective Study. Am J Sports Med February 1, 2012 0363546511434564
5. November 17, 2011