Hip Preservation Surgery Offers Less Invasive Treatment Options

Treatment options for younger patients with debilitating hip pain and dysfunction have historically been limited. Now, using minimally invasive techniques, surgeons at URMC are helping some patients improve their function and overcome long-standing hip pain without the need for joint replacement.

The use of hip arthroscopy for diagnostic purposes, loose or foreign body removal, and for debridement of cartilage or acetabular labral tears, has existed for decades. Over the last 10 to 15 years, however, advances in technology and technique have enabled hip arthroscopists to greatly expand their indications and intervene in a way once possible only through large open surgeries with substantial patient morbidity.

In addition to performing reparative and reconstructive procedures within the hip joint (hip impingement or FAI, labral tears, cartilage injuries, instability, and osteoarthritis), hip arthroscopists can now treat a variety of disorders in the bone and soft tissue structures outside the hip joint, as well (gluteal injuries, trochanteric bursitis, snapping hip conditions). Reliable and sustained results have been widely reported in the orthopaedic literature for a diversity of patient types.

hip arthroscopy“Pain around the hip area often presents a diagnostic challenge,” said Brian D. Giordano, M.D., assistant professor in the Department of Orthopaedics at URMC. “Younger patients with hip pain can be extremely disabled although their injuries are subtle and they do not exhibit characteristic signs of arthritis. Hip arthroscopy answers many puzzling diagnostic questions about the origin of a patient’s pain, and offers minimally invasive interventions that may result in significant functional improvement. Furthermore, patients with early or mild arthritis who are not ideal candidates for joint replacement may benefit from an arthroscopic approach to alleviating their pain.”

The outpatient procedure is performed arthroscopically through several 5- to 10-millimeter incisions, said Giordano, who was recruited to the Sports Medicine Division in 2010 after training at the Kerlan Jobe Orthopaedic Clinic Los Angeles. With traction, the hip joint is held apart slightly to allow the insertion of an arthroscope and working instruments into the joint capsule. The arthroscope is used to examine the joint and confirm any abnormalities visible on diagnostic imaging modalities, as well as those that evade diagnostic workup. Problems that are encountered are treated appropriately with a variety of specialized instruments, such as precisely contoured cutting and shaving devices, anchors, and electro-thermal cautery probes.

“Appropriately selected patients can have long-term benefits and may further reduce their risk of developing early onset osteoarthritis,” Giordano said. “Repairing or reconstructing structures within the hip joint can help improve joint stability by re-establishing the normal joint seal, thus preventing excess motion which can lead to abrasion and degeneration of the cartilage.”

Because hip arthroscopy is less invasive than traditional open hip surgery, it often means smaller incisions with a reduced risk of infection, an accelerated rehabilitation course, and a faster return to functional and recreational activities.

Hip arthroscopy is just one component of URMC’s comprehensive approach to musculoskeletal medicine. Other related orthopaedic services include adult reconstruction and joint replacement at the Evarts Joint Center at Highland Hospital, sports medicine specialists, orthopaedic trauma surgeons, and the nationally ranked pediatric orthopaedic group. It is the largest, most comprehensive orthopaedic group in the region, with more than 40 board-certified or board-qualified doctors who see more than 170,000 patients each year.

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