Sports expertise
Intensive sports practice is a risk factor for mechanical coxopathy. The sports involved include combat sports, team sports, dance, and all sports that involve extensive hip movements, pivots, and contacts. The onset of hip pain in a high-level athlete can jeopardize their sporting ambitions, passion, and income.
Management
The management of hip impingement or coxarthrosis in athletes requires highly specialized expertise, especially in high-level athletes. The first challenge is to make an accurate and early diagnosis.
The clinical examination during the consultation helps to specify the sports movement involved, the functional repercussions, and the athlete’s expectations, then the signs of hip involvement (stiffness, pain). Associated risk factors are also sought (family history of arthritis, hip trauma, childhood coxopathy).
Radiographs are taken from several angles: anteroposterior pelvis, Lequesne’s false profile, and Dunn’s profile. This looks for dysplasia (insufficient coverage), a femoral cam, or acetabular pincer (hip impingement), coxa valga, or coxa vara.
Cross-sectional imaging helps to clarify lesions of the labrum and cartilage: arthro-CT, MRI, or arthro-MRI. An infiltration may be proposed.
Solutions
Arthroscopy is the preferred treatment for hip impingement in athletes. It allows for the repair of a labrum lesion, assessment of the cartilage, and correction of malformations (femoral cam, acetabular pincer).
When performed early, hip arthroscopy allows for a return to high-level sports activity, including international competition.
The limitations of arthroscopy are hyperlaxity, severe dysplasia, deep chondropathy, and coxarthrosis.
Treatment Choice
A custom-made hip prosthesis is the treatment of choice for coxarthrosis in athletes, regardless of age, when medical and conservative treatments are surpassed.
The prosthetic implantation is planned in 3D using a specific CT protocol. A custom-designed and manufactured implant is used for optimal restoration of the muscular balance of the hip. The anchors are made of titanium, without cement. The 4th generation ceramic-on-ceramic sliding offers high mechanical resistance and low wear over time.
The prosthesis is implanted through an anterior approach to respect the muscles of the hip.
After a few months of recovery, sports can be resumed at the highest level without any restrictions.
Radioclinical follow-up is necessary throughout life.