Restricted range of motion, grade 4 chondral damage, and Tönnis radiographic changes greater than 1 are considered harbingers of poor outcome and possibly contraindications to hip arthroscopy. However, all of these findings are almost uniformly present among bull riders seeking treatment. The purpose of this study is to report on clinical observations in this population and outcomes of arthroscopic intervention, and how these observations may reflect on care in other cohorts.
Patients undergoing hip arthroscopy are prospectively assessed with a modified Harris Hip Score. Twenty-one consecutive hips among 16 bull riders (5 bilateral) were identified that had achieved minimum 2 year followup, and represent the substance of this report.
Among the 16 bull riders (21 hips) there were 14 professional and 2 collegiate cowboys. The average age was 26 years (range 20 - 33 years). Duration of symptoms averaged 33 months (range 2 – 130 months), and followup averaged 48 months (range 12 - 120 months). There were 10 right and 11 left hips. 14 of the cowboys were right handed, although only 13 rode right handed. The average weight was 155 pounds (range 125 - 170 pounds); height averaged 69” (range 66” - 72’). Range of motion was as follows: total arc averaged 31° (range 20° - 70°); internal rotation averaged 3° (range 0° - 20°); external rotation averaged 27° (range 20° - 50°).
All had FAI, including 17 combined and 4 cam type. Among the cam types, 1 also had dysplasia and 1 borderline dysplasia. Radiographic Tönnis grades included 2 Tönnis 1; 18 Tönnis 2, 1 Tönnis 3. All had acetabular articular damage including: 14 grade 4; 6 grade 3; 1 grade 1. Nine underwent microfracture. Four had accompanying femoral chondral lesions (3 grade 3, 1 grade 4). There were 20 labral tears of which 14 underwent repair and 6 debridement.
All but one (95%) were improved following surgery. One bilateral case underwent conversion to a resurfacing arthroplasty on one side and revision arthroscopy on the other. The average improvement was 22 points (preop 63; postop 85) with a range of -12 to 45 points. Thirteen cowboys (8%) returned to bull riding at an average of 7 months (range 4 – 17 months) There were no complications.
Discussion And Conclusion
Bull riders tend to be small framed like jockeys built for bulls. Tight hips associated with FAI may be a serendipitous adaptation for bull riders, providing a static (clothes pin) method for the thighs to grip the bull’s girth. Bull riders undergoing hip arthroscopy commonly carry a triple threat of predictors of poorer results: 1) Restricted motion, 2) grade 4 articular changes, and 3) Tönnis 2 radiographic findings. Despite these, with proper selection, they can often benefit substantially from arthroscopic intervention. Understanding the limits in this challenging population may help in deciphering the potential role of arthroscopy for challenging cases in other patient mixes.