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Hip pain is known to affect up to two-thirds of all people at some point in their life. It can be quite debilitating and affect some of the most basic activities of our lives. It can occur as the result of an injury or it can have a more insidious onset developing over months or even years.

When determining the cause of hip pain, we must first rule out other causes such as the lumbosacral spine or even a hernia. We must also confirm that hip pain is not being referred to another part of the body such as the common "knee pain" referred from hip pathology via the obturator nerve. Once it is confirmed that the hip pain is definitely coming from the "hip," we must then determine the type of hip pain it is.

There are two basic types of hip pain: groin pain and lateral hip pain. Groin pain generally refers to problems within the hip joint or anterior hip structures. The causes can be osteoarthritis, osteonecrosis, loose bodies, labrum tears, ligamentum teres tears, femoroacetabular impingement, fractures, tendonitis or internal snapping of the iliopsoas tendon. Lateral hip pain can be caused by bursitis, muscle strain, iliotibial band syndrome or external snapping.

Most hip pain is relieved with conservative measures such as physical therapy, anti-inflammatories, injections, or activity modification. Occasionally, a patient with hip pathology fails conservative management and becomes a surgical candidate. In the past, many of these patients were given the "all-or-none" ultimatum, which generally referred to "living with it" or getting a hip replacement. However, now there are new, minimally invasive procedures to address numerous hip complaints that can allow for a faster return to normal activities with less morbidity.

Hip arthroscopy has been thrust into the forefront of cutting edge sports medicine surgery. This minimally invasive technique allows for access to the hip joint and hip area without the need for larger incisions and painful dissections. A common injury treated by hip arthroscopy is the labrum tear. The hip labrum is the cartilage rim that surrounds the "socket" of the hip. When it is torn, often patients will describe groin pain, locking or catching. A hip arthroscopy can address these tears by repairing them with suture or debridement when they are unable to be repaired. Loose bodies can be retrieved via hip arthroscopy as well, obviating the need to open the hip, which results in much higher morbidity. A newer diagnosis that is becoming much more recognized is femoroacetabular impingement. This refers to when the hip ball-and-socket joint are not congruent either due to an excessive overhang of the socket or a bump on the ball, or femoral head. This condition has been shown to lead to early arthritis due to the "bumping" of the incongruent surfaces leading to labrum tears and joint deterioration. We can now treat this condition with hip arthroscopy by shaving down the incongruent surfaces. This allows for a more normal and fluent hip motion and may decrease the risk of labrum tears and hip arthritis.

An even newer technique involves the use of a hip arthroscope to perform a hip bursectomy and iliotibial band release due to hip bursitis and iliotibial band external snapping hip syndrome. Because this procedure is actually performed outside the hip joint but under the skin, it is termed "hip endoscopy." This very common condition is very debilitating for numerous patients. Although injections, physical therapy, and medications work for the majority of patients, some patients that do not respond to this treatment are often left out in the cold and told they must "live with it" because not even a hip replacement could cure this condition. Now, we have a procedure that can provide significant relief, if not cure this condition, and it is done though two small 1cm incisions!

Overall, it is a very exciting time in surgical advancements. Hip arthroscopy is the newest and one of the most cutting-edge techniques in minimally invasive surgery. When proper indications exist, hip arthroscopy can provide substantial relief of numerous conditions about the hip without the significant morbidity of the more traditional open techniques.


Dr. Reuss earned his M.D. degree with Honors from the University of Nebraska College of Medicine. He completed his Orthopaedic Surgery training at Orlando Regional Healthcare System. Following his residency, he pursued additional training in Sports Medicine by completing an Orthopaedic Sports Medicine Fellowship with the University of Cincinnati/Wellington Orthopaedics and Sports Medicine group. Dr. Reuss is a member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society of Sports Medicine, and the Arthroscopy Association of North America. He is board certified in Orthopaedic Surgery. Dr. Reuss specializes in sports medicine, knee, and shoulder injuries at Orlando Orthopaedic Center.

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