Obtaining second opinion from Dr. Makhni for Patients who still have pain following prior hip arthroscopy

Many patients may still have hip pain despite undergoing hip arthroscopy. There are actually many reasons why this may be the case. Please make an appointment if you would like to be evaluated for any of the following reasons:

Incorrect indication for surgery

One possible reason for still having pain after hip arthroscopy is is the original diagnosis was incorrectly made. Because there are so many different possible causes of hip pain - such as those related to the spine, low back, groin, or other nerve-related causes - it is extremely important that the correct diagnosis be made prior to undergoing hip arthroscopy. This diagnosis can be achieved through obtaining a thorough history and physical examination, along with testing such as advanced imaging (MRI) and ultrasound-guided injections. If any of these workups indicate a non-hip reason for your pain, a hip arthroscopy would be very unlikely to help fixing the underlying problem.

Alternatively, some patients have predisposing factors that might make hip arthroscopy unsuccessful, even when there is clear evidence of hip pain. These patients include those with dysplasia of the hip (developmental disorder of the hip) or those with arthritis. During your visit with Dr. Makhni, there may be alternative treatments available for these patients.

Incomplete resection of bony causes of impingement

One of the main reasons why patients have impingement is the bony abnormalities found either in the socket (acetabulum) or ball (femoral head/neck) of the hip joint. To fully treat the hip impingement, these bony abnormalities must be comprehensively removed and contoured. Sometimes, if not enough bone is removed in the process, there may be a residual bony abnormality that will continue to cause impingement and hip pain.

Patients who continue to have hip pain despite surgery may require a secondary surgery to remove the remaining bony causes of impingement. This can be determined by studying pre-operative x-rays and MRI's and comparing them to intra-operative arthroscopic photos as well as post-operative x-rays. When you visit Dr. Makhni, please be sure to bring all your records from your prior surgery with you for review.

Post-operative hip instability

During hip arthroscopy, the envelope that surrounds the hip joint (also known as the hip capsule) must be partially opened so that the arthroscopic instruments can be used to perform the procedure. At the end of the procedure, this capsule may not have been closed by the surgeon, or may not have healed after it was closed. Regardless, if the capsule does not heal back, the hip may be unstable due to the lack of supporting tissue in the joint. In some patients, this instability may cause pain and difficulty returning to strenuous or athletic activities.

Patients who have hip instability due to capsular deficiency may require a secondary procedure to repair the capsular defect that was created from the first surgery.

Incomplete - or inadequate - physical therapy after surgery

Another common reason for continued pain or disability after hip arthroscopy is incomplete or inadequate physical therapy following the first surgery. It is very important for patients to work with physical therapists who have expertise in working with patients who have undergone surgery for hip impingement. Additionally, it is very important for patients to diligently perform their post-operative therapy and exercises.

Dr. Makhni has identified several experts in physical therapy in the Detroit Metro (and surrounding) areas. if you feel that you require additional (and specialized) physical therapy, please schedule an appointment to see him and get a referral for therapy.