Logan Morrison Hip Impingement Q&A
Image courtesy of © Winslow Townson-USA TODAY Sports
Question 1: What is hip impingement?
Hip impingement is another term for what orthopedists call ‘femoroacetabular impingement’ or FAI. This term basically means pinching of the hip labrum tissue between the bone of the ball and the bone of the socket of the hip.
The hip is a ball and socket joint. Around the rim of the socket is a tissue called ‘labrum’ which acts as a cushion, and also seals the ball into the socket. In an ideal world, the ball is perfectly round and the socket is perfectly hemispherical. In this case, when people move the hip around, there is no pinching. However, in some people, rather than being round the ball is more shaped like a grape or an egg. In these cases the extra bone can cause a pinching of the labrum when the hip is flexed (for example, when seated). Over time, this repetitive minor injury can cause damage to the labrum. There can also be extra bone on the socket side, which can have a similar effect. These two situations are called CAM impingement (extra bone on the ball) and PINCER impingement (extra bone on the socket). In many cases, both CAM and PINCER impingement coexist.
Question 2: I don’t remember LoMo getting hurt. When did the labrum get torn?
Typically, this is not an injury that results from a single incident (though it can happen that way). It is much more common for this to be the result of an accumulation of ‘microtraumas’ over a long period of time.
In addition, the CAM and PINCER deformities are quite common in people who don’t have any pain in their hips. In some studies, >50% of asymptomatic patients have some signs of CAM or PINCER deformity on hip xrays. Simply having the ‘extra bone’ doesn’t automatically mean it is going to be a problem. Our understanding of why people develop these deformities is improving, but we don’t know the cause at this time. It appears to be more common in people participating in athletics (particularly hockey), so we think it has something to do with low-level trauma to the area during growth years.
Question 3: Does a labrum tear always need surgery?
No. A labrum tear is also a very common finding in patients with no hip pain. In one study of patients between 18-40 years old who had no hip pain, MRI’s of the hip showed a labrum tear about 40% of the time. So clearly not every labrum tear causes pain or requires surgery. There are also a number of conditions that can cause similar pain to hip impingement (ranging from hernias to pinched nerves in the spine to ‘sports hernias’ and many others). Therefore, time is often spent trying to decipher what the actual cause of the pain is in these patients, as it isn’t always as straightforward as we would like it to be.
Question 4: How do we tell which labrum tears need surgery and which do not?
This can be difficult, but typically rest, anti inflammatory medication, physical therapy and/or injections of cortisone are tried prior to surgery. Many patients can find success with these treatments. However, some do not, and surgery may be warranted.
Question 5: What is done during surgery?
There has been a significant evolution of techniques in hip surgery over the past decade as surgery for this condition has become more common. It can be done either open (through an incision) or arthroscopically (through the scope). Arthroscopic treatment is much more common, particularly in the United States.
The hip is stretched apart by use of a special table that pulls the joint open about 1cm. The scope is put in to the joint and tools are used to examine the joint space. We look at the surface cartilage, labrum and other structures in and around the hip. Once we have looked at everything, any ‘extra’ bone on the socket side is carefully removed with a tool called a burr. The labrum tear is often repaired with small anchors back to the rim of the socket (from where it tore away). The ball is then released back into the socket and we use the burr to reshape the ball, removing extra bone in that area as well.
Surgery often takes 2-4 hours depending on the extent of injury.
Question 6: How long is the recovery?
As with any surgery, the recovery is variable, but most high-level athletes are back to full sports around 6-8 months after the operation. There have been several studies examining the performance of professional athletes in different sports after return from this hip surgery. Most have shown little or no diminished performance after recovery.
I’m certain even Morrison would say he didn’t have the season he was hoping to have for the Twins, and this hip issue certainly could’ve been part of the reason. Hopefully he can improve after surgery and get back to his 2017 form, whether for the Twins or elsewhere.
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