Andrew Jimenez, MD; Mary Johnson
For years, Mary Johnson ran through the pain.
A runner since high school, she learned to push through the aches, strains and sore muscles that came with the sport even as she progressed to the sub-elite level – completing marathons in 3:06. But the pain that started in 2016 was not “normal.”
“It felt ‘crunchy’ in my hip. It was an untouchable, deep socket pain,” said Johnson, now 37.
She assumed she needed to scale back on running. Over the next few years, she tried cortisone injections. A doctor suggested strength training, which didn’t resolve the hip pain but “kept me off the OR table for a few years,” Johnson said. She gave birth twice – the pain got worse with each pregnancy. An MRI provided a “confusing result.”
“The pain was deep in my hip socket, but the MRI showed a stress fracture in my pelvis,” she said.
By 2022, Johnson was experiencing the worst pain of her life. That’s when she met Andrew Jimenez, MD, an orthopaedic surgeon at Yale New Haven Hospital and assistant professor of Orthopaedics and Rehabilitation at Yale School of Medicine, who specializes in sports medicine and hip preservation.
The next frontier in sports medicine surgery
Mary Johnson
Hip preservation, Dr. Jimenez explains, is applying operative or nonoperative techniques to treat non-arthritic hip pain and preventing a future hip replacement.
“Sports medicine surgery has historically focused on the shoulder and the knee, but the hip is the next frontier,” he said, adding that hip arthroscopy (a minimally invasive outpatient surgical procedure to diagnose and treat hip joint problems) is gaining increased attention. Patients typically return to full activity with faster recovery time than traditional surgery.
Before hip arthroscopy became mainstream, the hip joint was hard to access. “People in their 30s or 40s would start to have hip pain, and we would think it was early arthritis. We would give them injections until they needed a hip replacement sometime in the future,” Dr. Jimenez said. “But now, with greater understanding of the hip and better technology, we are able to help repair damaged structures before arthritis sets in, such as fix a labral tear or hip impingement.”
Dr. Jimenez diagnosed Johnson with a tear in the hip labrum, which is the ring of cartilage that follows the outside rim of the hip joint socket. The labrum cushions the hip joint and acts like a “seal” to help hold the ball at the top of the thighbone securely within the hip socket. A tear in the labrum can cause hip instability and increase the stress on the cartilage – raising the risk for developing osteoarthritis in the affected hip.
Symptoms and treatment
Symptoms of a torn hip labrum include:
- pain in the front of the hip and/or groin, buttock, thigh or knee;
- a clicking or locking sensation in hip;
- a feeling that the hip joint is “giving way.”
Initial treatment for most labral tears is nonsurgical. Treatments may include a combination of modifying the activities that cause pain; nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to help reduce inflammation and pain; corticosteroid injections; and physical therapy. If nonsurgical treatments don’t solve the problem, surgery may be recommended.
For Johnson, hip arthroscopy was the answer. “By this point, I’d already gotten a cortisone shot, done years of physical therapy and was taking lots of NSAIDs to deal with the throbbing pain,” she said. “Ten days after my appointment with Dr. Jimenez, I had surgery. It was the best decision I ever made. Within 48 hours, almost all of the referred pain symptoms were gone and I knew right away that it was a success.”
While she was able to resume daily activities quickly, Johnson’s return to the pavement loomed as a bigger question. “I asked Dr. Jimenez if I would be able to get back to high-level running. He said he would do everything in his power to get me there,” she said.
Just sixteen months later, she ran her first post-op marathon – and finished in 3:08, just 90 seconds off her personal best. She is confident that she will continue to improve.
“Dr. Jimenez and the hip preservation program at Yale New Haven Health changed my life,” she said.
Learn more about Orthopedic Services at Yale New Haven Hospital
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