Hip pain doesn’t just plague people in midlife and beyond.
Sometimes, young, healthy people can experience debilitating hip pain. Ahmad Homsi, a 16-year-old athlete and student at Olympic High School in Charlotte, North Carolina, found himself in just that position last year.
“I wanted to run, jog, play soccer and box,” Ahmad said. “But my hip pain was interfering with all of it. The pain was bad and pretty consistent.”
The pain became chronic. “He wasn't able to play soccer as much as he wanted to, and it was affecting other areas of his life, too,” said Dr. Landry Jarvis, an orthopedic surgeon at Novant Health Orthopedics & Sports Medicine - Ballantyne.
Jarvis determined that Arhamd had hip “impingement” that was interfering with the normally smooth ball-in-socket joint movement.
“This could be a bone-shape problem that you’ve developed,” Jarvis said of the issue that may have led to Ahmad’s pain. “Certainly, if you're playing soccer where you're kicking all the time, you can get a repetitive impingement. And that’s what ultimately tears the labrum,” a protective ring of cartilage in the joint.
Surgeons typically start with conservative treatments. So, Jarvis first recommended activity modification, exercises and over-the-counter anti-inflammatories. After three months, the pain had not diminished. Jarvis recommended surgery, much to the surprise of Michael Homsi, Ahmad’s father. Both father and son were shocked by the news. Sixteen seemed too young to need hip surgery.
But they quickly understood that was the best route. “Dr. Jarvis said if Ahmad didn’t have surgery now, he may need a hip replacement by the time he’s in his late 30s,” Michael said. “We realized then there was no way to avoid surgery.”
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Jarvis recommended a minimally invasive procedure, called a hip scope, which falls under the scope of “hip preservation” surgery. In Ahmad’s case, this was performed bilaterally – more on that in a moment – in a two-stage process.
This procedure is done in an outpatient setting, and the patient can go home the same day. Here’s how it works: Through pin-hole incisions, Jarvis inserts a camera and a small cutting tool to smooth over the irregular bone growth, which removes the impingement and allows the femoral head to rotate freely. Next, he repairs and reattaches the torn labrum to the bone.
Ahmad was fortunate to have been referred to Jarvis; he’s one of just a few hip preservation specialists in North Carolina.
“In bilateral cases, we stage the two surgeries six weeks apart, and that gives the patient time to fully recover on one side before they get the other side done,” Jarvis said. “I haven’t yet had a patient back out after having just one side done. They know how much better the first hip is after the first surgery and are excited to get the second one fixed. It's really exciting how effective this surgery can be in the right patient.”
Ahmad’s surgeries were performed at Novant Health Matthews Medical Center. Jarvis operated on his right hip – the more painful of the two –in December 2021. Six weeks later, Ahmad had his left hip done.
Ahmad’s was a chronic injury, but this hip preservation procedure works for acute, or accidental, injuries, too.
“The recovery can be challenging for some people, but not for young athletes like Ahmad,” Jarvis said. “They have no problem with it – three weeks of crutches and a brace and that’s it. Athletes can get back to playing sports about four months post-surgery.”
“Ahmad was a phenomenal patient,” Jarvis said. “He was ready for it. He bounced back really quickly.”
People who have lost cartilage in their hip due to moderate to severe arthritis are not typically candidates for this surgery. “With significant cartilage loss, a total hip replacement is probably more effective than a hip scope,” Jarvis said.
“When I looked at Ahmad, his cartilage was fine, but he had this huge impingement,” Jarvis continued. “And he was already having symptoms at such a young age. He was someone who was probably destined to get a total hip replacement later in life if he hadn’t had his hips scoped.”
“By removing his impingement so early, he didn't accumulate the cartilage damage that he otherwise would have,” Jarvis added. “Theoretically, the sooner you act on this problem – the younger the patient is – the less likely they are going to need a total hip replacement later.”
A hip scope is typically done in patients 45 and younger. “The oldest patient I've done hip preservation surgery on was 65.” Jarvis said. “It’s something to consider if you don’t have arthritis.”
Ahmad appreciated how quickly he was able to get his old life back. He said, “About 99% of the pain is gone now. Since late February, I’ve felt a lot better. I finished PT (physical therapy) and took up soccer again in late spring. I have no limitations now.”