AANA Hip Arthroscopy - September 2024-Pearls and Pitfalls of Patient Selection in Hip Preservation Practice

Video Transcription

Video Summary

John Cristoforetti, a sports medicine surgeon in a hip preservation team, shares “pearls and pitfalls” for selecting hip preservation patients. His central message is that comprehensive diagnosis matters: clinicians must integrate the patient’s functional demands, mechanical anatomy, and individual healing/psychological capacity. He emphasizes parallel diagnostic pathways to distinguish acute injuries from long-standing stiffness and pain, and to evaluate mechanical contributors such as dysplasia, femoroacetabular impingement, torsion, and extra-articular impingement. Preoperatively, teams must align goals—cartilage preservation and arthritis delay may differ from a patient’s desire for pain relief and life restoration. He recommends ultrasound-guided diagnostic injections with provocative maneuvers to identify true pain generators versus multifactorial or non–hip-preservation problems (advanced arthritis, chronic neurogenic pain). He highlights screening for catastrophizing and using patient-reported outcomes to set expectations, build durable care relationships, and allocate team resources. Ideal candidates have predictable, intermittent anterior/C-shaped pain with a correctable mechanical conflict; snapping symptoms may signal instability/dysplasia and warrant caution.

Keywords

hip preservation patient selection

comprehensive hip diagnosis (functional demands, anatomy, healing capacity)

femoroacetabular impingement (FAI) and hip dysplasia evaluation

ultrasound-guided diagnostic hip injections with provocative maneuvers

patient-reported outcomes and catastrophizing screening