Hip

Orthopedic Hip Surgery in Indianapolis, IN and Mooresville, IN

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Hip Impingement

Hip Arthroscopy

Hip Impingement (Labral Tears / CAM & Pincer Deformity)

Your hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis. The ball is the femoral head, which is the upper end of the femur (thigh bone). The surface of the ball and socket is covered with cartilage, a smooth, coating layer that protects the bones and enables them to glide easily across each other. The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum, often referred to as the “gasket” of the ball and socket joint, forms a seal around the socket, creating a tight suction and helping to provide stability to the joint.

In hip impingement (also known as femoroacetabular impingement or FAI), bone overgrowth (bone spurs) develop around the femoral head and/or along the acetabulum. These bone spurs cause abnormal contact between the hip bones, oftentimes limiting movement and preventing smooth motion. Over time, this can result in tears of the labrum and breakdown of articular cartilage (osteoarthritis).

There are three types of FAI: pincer, cam, and combined impingement.

Pincer—extra bone extends out over the normal rim of the acetabulum (socket). The labrum (cartilage seal) can be crushed under the prominent rim of the acetabulum.
Cam—the femoral head (ball) is not round and cannot rotate smoothly inside the acetabulum (socket). A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum.
Combined—both the pincer and cam types are present.

Non-operative treatments:

Activity changes—modify high impact activities and positions where your hip is maximally flexed
Non-steroidal anti-inflammatory drugs (NSAIDs)—medications like Aleve (up to 2 pills twice a day with food) can help reduce pain and inflammation.
Physical therapy—specific exercises can improve the range of motion of the hip, strengthen the muscles that support the joint, and alter joint mechanics so there is less impingement between the bones. Therapy can relieve some stress on the injured labrum or cartilage.
Hip injection under fluoroscopy (x-ray)—steroid injections into the hip may also help with symptoms. Injections can also better pinpoint where hip pain may be coming from. Since the hip joint is deep, buried under many muscles, x-ray is used to make sure the medicine is delivered into the hip joint itself. This procedure is performed at the surgery center under a small amount of local anesthesia (numbing medicine at the skin).

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Hip Arthroscopy

Hip arthroscopy is a surgical procedure that allows doctors to view the hip joint without making a large incision. During hip arthroscopy, an arthroscope (camera) is inserted into the hip joint. The camera displays pictures on a video monitor, and these images are used to guide surgical instruments. Because the arthroscope and surgical instruments are thin, small incisions may be used, rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to previous activities. Surgery is performed under general anesthesia and is done as an outpatient. All of the procedures listed below can be performed during the same surgery.

Labral repair: the “gasket” that surrounds the acetabulum (socket) is called the labrum. This provides a suction seal of the ball-and-socket joint, giving stability to the hip. If non-operative treatments have failed to relieve pain associated with a labral tear, hip arthroscopy can be used to fix the labrum and improve the stability of the joint.

Femoroplasty: in patients who have a cam deformity (bony bump over the front of the femoral head), a burr can be used to remove the bump to prevent further pinching of the bone spur against the labrum. X-ray is used during surgery to make sure an appropriate amount of bone is being removed and at the right location. There is a small risk of fracture of the femur, so you will be on crutches for 2 weeks after this type of procedure. There is also a small risk of extra bone forming in the hip (heterotopic ossification) from the bone shavings. To prevent this, you will be prescribed a powerful anti-inflammatory called Celebrex for 2 weeks after surgery.

Acetabuloplasty: Similar to the bony bump on the femoral side, bone spurs can occur on the acetabular (socket) side. This is called a pincer deformity. The bone spur on the socket can be removed in the same manner as the bone spur on the femoral side. There is lower risk of fracture with this procedure as compared with the femoroplasty. There is still the same risk of heterotopic ossification, so patients are required to take Celebrex for 2 weeks after surgery.

Iliopsoas fractional lengthening: in a small percentage of patients, deep groin pain can be accompanied by more superficial (closer to the skin) discomfort, often caused by iliopsoas (hip flexor) tendinitis and/or bursitis. Pain can be reproduced with pushing down on a leg that is being lifted up. Some movements of the hip can also cause snapping or popping. If non-operative treatments have failed to improve pain, the iliopsoas tendon can be lengthened during hip arthroscopy. The tendon is not “cut”, but rather “lengthened” in the area where the tendon and muscle combine (musculotendinous junction) immediately in front of the hip.

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Helpful, kind and made it as easy as possible!

“Dr. Calloway did my surgery. He's personable, up front about what your problem is and how to solve it, and open to any questions with a great bedside manner. The surgery went perfectly to the point where I was basically a little weirded out about how well it went. I had a similar surgery on my left shoulder as I did in my right shoulder, a few differences, and this particular shoulder surgery with Dr. Calloway went smooth as butter. His office staff is very nice and personable as well. No one there makes you feel like a dollar sign. When the surgery time came Dr. Calloway came to my room and pre-op to explain what was going to happen and try to call my nerves, as I have an extreme fear of going under anesthesia. He and the surgery staff were helpful and kind and made a difficult experience is easiest possible.”

Excellent Surgeon!

“Excellent surgeon! He's friendly, personable, knowledgeable and does a great job of explaining what he's going to do and what he did do after surgery.”

I have no pain, no popping, my mobility is great!

“Dr. Calloway was great to work with. After dislocating my shoulder multiple times he suggested latarjet procedure. I am now 9 months post surgery and my shoulder feels great, my incision healed very well. I have no pain, no popping, my mobility is great and my shoulder feels secure again witch I am very thankful as I do tree work and need to use my shoulders a lot. Dr. Calloway patiently answered every question I had thoroughly and I believe he set me up for the best recovery possible.”

The surgery results were great!

“I had no problems getting scheduled for appointments or for surgery. He was very friendly and courteous and gave realistic expectations about my rotator cuff surgery. He took the time to explain exactly what procedures were to be used. He answered all my questions. The surgery results were great. He was very much engaged in getting me back on the golf course with his recommendations for physical therapy and encouragement. I would definitely recommend him to others and if I need surgery on my other shoulder he will be my first choice.”

This is the first I've been painfree!

“I was referred to Dr. Calloway as a last resort. He was honest up front and told me he couldn't guarantee that he could be any help. I underwent arthroscopic surgery to have scar tissue cleaned up and he performed a tendon release on my hip. One week after surgery I am having no pain and much more mobility. This is the first I've been painfree in more than 6 years.”