What is the initial approach to managing bilateral cam morphology hips?

From the Guidelines

The initial approach to managing bilateral cam morphology hips involves conservative, non-surgical treatment, focusing on activity modification, physical therapy, and pain management, before considering surgical options like hip arthroscopy with femoroplasty. This approach is based on the principle of minimizing morbidity, mortality, and improving quality of life, as many patients with cam morphology remain asymptomatic or can manage symptoms effectively without surgery 1.

Key Components of Conservative Management

• Activity modification to avoid positions that cause impingement, particularly deep flexion and internal rotation of the hip
• Physical therapy focusing on core strengthening, hip stabilization, and improving range of motion, which should be pursued for at least 3-6 months before considering surgical options
• Pain management using non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for short periods during pain flares
• Intra-articular corticosteroid injections for temporary relief in patients with significant symptoms
• Weight management, as excess weight increases joint stress

Rationale for Conservative Approach

The underlying mechanism of pain in cam morphology involves abnormal bone formation at the femoral head-neck junction causing impingement against the acetabulum during certain movements, leading to labral tears and cartilage damage over time 1. Conservative management aims to reduce symptoms and slow disease progression, thereby improving quality of life and delaying the need for surgical intervention.

Surgical Considerations

Only when conservative measures fail to provide adequate symptom relief should surgical interventions like hip arthroscopy with femoroplasty be considered. The decision to proceed with surgery should be based on individual patient factors, including the severity of symptoms, extent of cartilage damage, and presence of other hip pathologies 1.

Evidence Support

Studies have shown that conservative management can be effective in managing symptoms and improving function in patients with cam morphology hips 1. While surgical options like hip arthroscopy with femoroplasty may be necessary for some patients, the initial approach should always prioritize conservative, non-surgical treatment to minimize morbidity, mortality, and improve quality of life.

From the Research

Initial Approach to Managing Bilateral Cam Morphology Hips

The management of bilateral cam morphology hips is a complex issue, and the initial approach may vary depending on several factors, including the presence of symptoms, the severity of the deformity, and the patient's overall health.

• The study 2 suggests that a one-stage approach, combining hip arthroscopy and contralateral total hip arthroplasty, may be effective in managing bilateral cam morphology hips with associated labral tears and osteoarthritis.
• However, the study 3 found that there was no significant difference in T1ρ relaxation times between symptomatic and asymptomatic hips with bilateral cam morphology, suggesting that the presence of a cam deformity may predispose to hip joint cartilage degradation and increase the risk of hip osteoarthritis, regardless of symptoms.
• The study 4 identified differences in anatomical parameters between affected and unaffected hips in patients with bilateral cam-type deformities, including decreased femoral neck-shaft angles and medial proximal femoral angles in affected hips.
• The study 5 found that correcting cam morphology may positively affect the natural history of femoroacetabular impingement, with improved patient-reported outcome scores and reduced risk of progression to arthroplasty.
• The study 6 reported a high prevalence of cam-type morphology in asymptomatic patients, with no correlation between the presence of cam-type morphology and range of motion, positive impingement test, or labral tears.

Key Considerations

• The presence of bilateral cam morphology hips requires careful evaluation and consideration of the individual patient's symptoms, radiographic findings, and overall health.
• A comprehensive treatment plan may involve a combination of surgical and non-surgical interventions, including hip arthroscopy, total hip arthroplasty, and physical therapy.
• Further research is needed to determine the optimal treatment approach for bilateral cam morphology hips and to better understand the natural history of this condition.