Summer 2012

Choosing Minimally Invasive Procedures for Hip Damage

"In the last 10 years, our understanding of smaller intra-articular injuries to the hip has grown, and so has our ability to diagnose and treat these conditions with nonoperative and minimally invasive procedures," says hip surgeon Brian Feeley, M.D., of the UCSF Department of Orthopaedic Surgery.

"Surgeons who treat the entire spectrum of hip disease are better positioned to help patients understand and choose from various treatment options, from hip arthroscopy to a mini-open procedure, or even hip replacement," says Thomas Vail, M.D., chair of the department. "Today there's a developing body of literature showing that in well-selected hip conditions, joint preservation rather than hip replacement is possible and patients can have great outcomes."

One important key to patient satisfaction with the outcome of surgery is that the surgeon has the knowledge to guide patients through the decision-making process, as well as extensive experience with the full range of procedures.

Treating Labral Tears and Hip Impingement

Feeley says that the decision about how best to proceed typically begins with the primary care physician who sees a patient with activity-related pain in the groin and front of hip, as opposed to the back of the leg. These are signs of a possible labral tear.

"In these situations, most primary care physicians can first utilize X-rays to look at the bony morphology of the hip and see if there is an underlying structural cause of pain," says Feeley. "That's usually followed by an MRI to evaluate the status of the cartilage as well as the labrum within the hip joints."

If the tests reveal labral damage or evidence of impingement, that's an ideal time to refer the patient to a specialist for treatment.

  • For some conditions, the specialist's first step is activity modification with oral anti-inflammatories and physical therapy. "Many patients get better without any surgery at all," says Feeley.
  • When surgery is required for a labral tear in the hip, Feeley says research has shown that labral tears can be particularly responsive to arthroscopy. In these procedures,
    • Surgeons make two or three small incisions on the outside of the hip.
    • Depending on what they find, they then debride or repair the labrum.
  • "To prevent recurrence, we identify and treat any abnormal bone morphology that could be the cause of the underlying problem," says Feeley. On occasion, this may require a minimally invasive open procedure.

Expected recovery from the arthroscopic procedure ranges from approximately three weeks to four months, depending on the condition. Most patients make a full recovery and return to athletics and work.

Refer for a suspected labral tear when patients have all of the following conditions:

  • Groin pain with activity
  • Radiographs demonstrate abnormal femoral neck or acetabular morphology
  • MRI reveals a labral tear

Dr. Brian Feeley and Dr. Thomas Vail can be contacted at (415) 353-2808.

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Orthopaedic Surgery News — Summer 2012 Index

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