In 2013, when New York Yankees shortstop Alex Rodriguez underwent hip arthroscopy for a torn labrum and bone impingement, it was considered a radical move. But after the two-hour procedure and a six-month recovery, Rodriguez was playing so well that he earned consideration for Major League Baseball’s Comeback Player of the Year Award. While hip arthroscopy has worked for several professional athletes over the years, it’s now becoming an increasingly popular solution for weekend warriors whose active lifestyles are hindered by hip pain.
To understand the allure of the procedure and why more active patients under the age of 45 are opting for it, we spoke to John Christoforetti, M.D., an orthopedic surgeon and sports medicine specialist on the medical staff at Texas Health Allen and at Allen Orthopedics and Sports Medicine, a Texas Health Physicians Group practice.
“Weekend warriors are just as susceptible to hip injuries as athletes, especially those who participate in endurance athletics or high-impact training activities that can overload the hip and surrounding structures,” he explains.
Why? Anything from sitting at your desk all day to your weight, gender or family history can affect the health of your hip joints. But overtraining beyond the body’s recovery limits or through pain can also create a vulnerability to injury.
So what activities are most likely to lead to an athletic hip injury in someone who isn’t a professional athlete? For that answer, Christoforetti says it depends on the person’s gender. For women, the most common activities are running, soccer, yoga or gym activities. Injured men tend to participate in rotational, pivoting sports such as hockey, baseball and soccer — as well as the activities associated with female injuries. The common thread: repetitively training or playing a sport that forces the hip joint into an over-tight or unstable position.
With the popularity of high-impact fitness classes, activities and recreational league sports rising among the Millennial (1981-95) and Generation X (1965-1980) populations, it’s no wonder more people are finding themselves dealing with hip pain that requires surgery. Christoforetti notes that in a database of thousands of cases of arthroscopic hip surgery collected across the United States, the vast majority of patients are active, but not professional athletes.
“We stay active as we age in many ways that older generations did not,” he explains. “Squatting, pivoting, jumping and even contact or extreme sports are common among 30- to 50-year-old patients. In the past, many hip injuries were simply ‘career enders.’ Now, active adults can be accurately diagnosed, and through advances in technology and surgical skills, we can perform minimally invasive surgery to repair the problem using arthroscopy of the hip as a tool. After rehabilitation, they can enjoy many years of return to activity.”
Hip arthroscopy is a minimally invasive procedure that allows doctors to view the hip joint without making a large incision through the skin and other soft tissues, which can result in less pain for patients, less joint stiffness and a shorter recovery time, making it a more appealing choice to weekend warriors over a traditional hip replacement. In fact, outpatient hip arthroscopy is forecasted to rise in popularity among U.S. adults 179 percent by the year 2028.
Christoforetti explains that hip arthroscopy procedures are performed on an outpatient basis, with most patients heading home the same day. Patients then return to the office the next day to discuss the success of the surgery and go over a plan for recovery. Crutches or a walker plus a hip brace may be used to protect the healing tissues for two to four weeks, and by week six, most patients can walk without the use of assistive devices.
“Daily home exercises and use of a special hip motion machine allow for a rapid return to daily function,” Christoforetti says. “But for those who have highly-active goals, weeks six through 20 after surgery involve physical therapy to build core strength and endurance, with a return to full sporting activities without limits possible about four to six months after surgery.”
Christoforetti even touts that more than 85 percent of hip arthroscopy patients return to running before the six-month mark post-surgery.
The best candidates for hip surgery include patients who have:
- Mild or no arthritis (worn-down ball and socket);
- Pain that occurs intermittently or following exercise/sporting activity but resolves when those activities are avoided;
- A healthy body weight;
- Normal hip bone structure;
- No history of narcotic (opioid) use;
- Hip pain lasting less than six months
Likewise, there are also a few possible conditions that can limit the success or recovery rate of hip surgery. These include but are not limited to:
- Chronic, constant severe pain unrelated to activity
- Pain at night
- Pain that requires narcotic medicine
- Severe hip arthritis
- Severe developmental hip conditions
- Avascular necrosis of the hip
- Severe depression or anxiety
- History of prior spinal conditions requiring treatment
Even minimally invasive surgeries such as hip arthroscopy are always the last resort in your doctor’s treatment plan. Christoforetti says many non-surgical treatment options can help alleviate joint pain, including rest, medications such as analgesics or antibiotics, injections, and physical/occupational therapy.
“While prevention of injury is never 100 percent possible, our experience allows us to make a few suggestions,” Christoforetti adds. “Stretching should not be extreme, produce deep joint pain, or be combined with heavy impact training immediately following a deep stretch, such as running after performing yoga. When the hip joint feels as though it wants to stop rotating during exercise, avoid rotating further to protect the cartilage and tissues from injury.
“Most importantly, in our mid-adult years, we need more time to recover and warm up before explosive training to avoid problems.”