PHOENIX (Ivanhoe Newswire) - Popping the bone out of the socket, huge incisions that leave huge scars and a lot of down-time. That's what many hip surgery patients have to go through. Now, a new innovative treatment is cutting pain and recovery time with much smaller cuts.
She used to run 26.2 miles at a time, but recently, Meghan Krein couldn't run without excruciating pain.
"You know the worst case scenario going through my mind was I might never be able to do this again," Meghan Krein, told Ivanhoe.
She was suffering from abnormal contact between the bones of her hip. It can tear the labrum, which is soft tissue that cushions the joint like a gasket. Dr. Matthew Hansen specializes in helping people with the painful problem.
"In somebody like Meghan, when the socket was a little bit too deep and rotated toward the back, this predisposed her to getting pinching of the labrum, particularly when she tried to flex her hip," Matthew L. Hansen, M.D., an orthopedic sports medicine specialist at The Core Institute, said.
Surgical repair used to mean a large 8-inch incision, even dislocating the hip. The latest arthroscopic technology allows surgeons to trim bone and repair labral tears through a few one-centimeter incisions. Depending on the patient, recovery time varies from four to 12 months. Bouncing back from traditional hip surgery can take up to 18 months.
"So this is a tremendous breakthrough from a patient's perspective because the recovery is so much quicker," Dr. Hansen said.
Meghan was on a stationary bike just hours after surgery, and walking on crutches the same day. Now, she's pedaling fast toward a full recovery.
"I could do cartwheels. I'm so thrilled!" Meghan said.
This procedure isn't just for adults, doctors perform hip arthroscopy on patients in their teens and younger. It's covered by insurance, and generally gives patients permanent relief from their pain.
BACKGROUND: The labrum is a unique structure found in the hip; it lines the edge or rim of the hip socket. The shape and function of the labrum is similar to a bumper cushion on a pool table. The shape of the labrum is triangular in cross-section. It acts as a cushion between the ball and socket of the hip joint during flexion of the hip and it holds the thighbone (femur) in place. The labrum is filled with nerve fibers that make tears in the labrum very painful SOURCE: (www.dukehealth.org)
CAUSES: A hip labral involves the labrum. Labral tears typically occur from: repetitive motion; osteoarthritis, trauma; or it may be caused by a birth defect SOURCE: (www.dukehealth.org)
SYPMTOMS: Some labral tears cause no signs or symptoms. However, when symptoms are present, they include: radiating pain in the hip and groin; a catching or locking sensation in the hip joint; stiffness in the joint; or a limited range of motion SOURCE: (www.dukehealth.org)
RISK FACTORS: People with pre-existing hip problems are at a higher risk of experiencing a hip labral tear; also people who participate in sports or other activities that require repeated twisting or pivoting motions SOURCE: (www.mayoclinic.com)
TREATMENT: The level of treatment depends upon the severity of the condition. Some patients recover in only a few weeks using conservative treatments. However, patients with severe labral tearing may require surgery. One or a combination of these treatments may be used: rest and activity modification; medication; physical therapy; or surgery may be needed to repair or remove the torn portion of the labrum. SOURCE: (www.dukehealth.org); (www.mayoclinic.com)
THINGS YOU DIDN'T KNOW: A hip labral tear rarely occurs in isolation. In most cases, other structures within the hip joint have also sustained injuries. Patients with a hip labral tear may develop osteoarthritis in that joint in the future SOURCE: (www.mayoclinic.com)
LATEST BREAKTHROUGHS: Hip arthroscopy is an excellent solution for relieving hip pain; the surgery repairs the damaged hip by separating the ball and socket in the hip joint. The procedure is an outpatient procedure that requires small leg incisions and promotes accelerated rehabilitation. For patients younger than 40, who have good cartilage and healthy joints, it is a great solution for treating hip pain in a minimally invasive manner. For patients over 40, who have the preservation of articular cartilage, arthroscopy can provide significant relief for the specific conditions. Recover time for arthroscopic surgery is much less than the traditional, people who have this surgery can return to their normal activities in four months to a year, unlike with the traditional surgery which could have patients out for a year and a half SOURCE: (www.dukehealth.org)
Dr. Matthew Hansen, Orthopedic Surgeon, talks about performing arthroscopic hip surgery on patients with abnormal hip and socket joints or patients who have had an injury to their hip.
What kind of problems are we talking about when people come to you?
Dr. Hansen: The number one problem that they complain about is pain in the groin, the front part of the hip. Occasionally they'll have symptoms like locking or catching or snapping or popping in the hip but mostly pain.
This is different than somebody who might be a candidate for total hip replacement, why?
Dr. Hansen: It's different in the sense that we can preserve the hip, we can operate with an arthroscope through tiny incisions and change the anatomy of the hip to eliminate the pain. And not have to replace the entire hip like you would with hip replacement.
Why are people having these problems is it over use or exercise?
Dr. Hansen: Well it's a combination of abnormal anatomy, the hip is typically a very specific ball and socket joint and if there's a problem with the shape of the ball or the socket or in some cases both then over time that can put additional stresses on the other structures of the hip and cause damage which results in pain.
What is your goal in this surgery, what are you trying to do?
Dr. Hansen: Initially we would try to correct any of the bone abnormalities so we would change the shape of the bone to a more proper shape. But also any torn or damaged structures we would also repair.
How was this done before, what was the traditional old way of doing this?
Dr. Hansen: The traditional way was with a relatively large incision, open surgery. Where the hip would even be dislocated, sometimes the hip bone itself would be cut just to gain access in to the joint. And then that would have to be repaired afterward, it resulted in a relatively lengthy recovery. And so now what we can do is with just a few small incisions just big enough to put something as big as the end of a pencil inside we can accomplish the same thing in a much less invasive fashion.
So what kinds of things might you be doing for a patient like Megan?
Dr. Hansen: In somebody like Megan where her socket was a little bit too deep and rotated towards the back this predisposed her to getting a pinching of the labrum, particularly when she tried to flex her hip. And so in her case what we did is we trimmed the bone and made the socket a more normal shape and then repaired the torn labrum.
How do you do that?
Dr. Hansen: With the scope or the small camera inside the joint we can see everything that's going on right inside the ball and socket joint. We see the labrum, we see the articulate cartilage and the shape of the bone and we use small shavers kind of like a Dremel motor drill if you've seen those. And literally shave off some of the bone and reshape it. For the torn labrum we use small anchors and these are anchors that are typically made out of biocompatible plastic or even a bioresorbable plastic that go in to the bone and act tent pegs. And there are sutures attached to these anchors which we then wrap around the labrum and tie it back down to the bone.
How much as the innovation and new materials and technology changed this procedure?
Dr. Hansen: It's changed it radically in the last few years. Even just four or five years ago we didn't have the ability to put these types of anchors in and certainly didn't have the same instrumentation. Any time you're doing a minimally invasive surgery the instrumentation is going to be very important, it has to be just right so you can do a lot of surgery through a little incision. And that's what's happened in the last few years, the instrumentation as well as the implant have really advanced to the point where we can accomplish it.
Is this a breakthrough in terms of how you do this and the technology?
Dr. Hansen: Let me give you an example from a patient's perspective. After a hip scope for instance like Megan, the patient goes home the same day. I want them on their stationary bike starting to move their hip, they're walking with a crutch and they start therapy the next day. They usually get rid of their crutches within two weeks. In contrast if you have a cut made in your bone and have it repaired then you're on crutches for six weeks, you're not moving nearly as quickly and recovery is a lot longer. So this is a tremendous breakthrough from the patient's perspective because the recovery is so much quicker.
And this is not just for an elderly person, this is an active people kind of thing?
Dr. Hansen: Exactly, most of my patients are athletes whether they're weekend warriors or they run every day or cycle every day. But occasionally we'll also see patients who have been involved in motorcycle accidents or automobile accidents or other injuries that we can fix as well. But the majority of them are active patients.
As an orthopedic surgeon and a sports medicine surgeon your goal is to get people up on their feet as quickly as possible, tell me about that.
Dr. Hansen: Absolutely. We want to prevent some of the problems that come from immobility such as decreased muscle tone, formation of scar tissue, deconditioning and so we start right away. And that's why I have patients go to therapy, physical therapy the day after surgery so they can start activating those strong muscles around the hip and getting them working again .
Is this a permanent fix?
Dr. Hansen: We don't know for sure, I'm honest with my patients when we talk about it in the office. What we know is it does a very good job of pain relief and there's good studies that show for two years and some other studies that should be coming out soon showing about ten years of very good pain relief. But we don't know for sure if it's permanent yet.
Tell me the difference between somebody who needs a hip replacement and somebody who needs this procedure.
Dr. Hansen: Somebody who needs a hip replacement essentially their hip is too far gone. Typically that involves injury to the articular cartilage and that's the smooth coating over the ends of the bone. You may have seen it if you've ever cooked a drumstick it's the white stuff over the knobby part of the bone. Once that wears out we don't have a good way to fix that arthroscopically. However if you have this impingement or labrum tears those are the problems we can fix arthroscopically. If you have significant loss of the articular cartilage you're probably better off having a hip replacement it's a more reliable way to alleviate pain.
This procedure is called hip arthroscopy?
Dr. Hansen: Well hip arthroscopy, an arthroscope is a tool. It's a way to look inside the joint. And whether you repair the labrum or take off the bumps through an open incision or with the arthroscope you're still accomplishing the same thing on the inside. The fact that we call it hip arthroscopy and use the scope just tells you that it's minimally invasive. It's all those benefits that we talked about in terms of how rapid you get back on your feet and you recover, a little bit less pain that's the benefit of using arthroscopy. Some of the other names we talked about would be labrum repair, rim trimming, osteoplasty those are kind of the top three procedures we do inside the hip while we're looking at it with the scope.
Has hip been one of the later ones, we've done knee surgery forever, shoulder surgery forever is hip the later one?
Dr. Hansen: Well it's certainly the forefront right now. It's probably ten or fifteen years behind the shoulder arthroscopy and even further behind knee arthroscopy. But the interesting thing is even the shoulder and knees were seeing some advancement but I think we'll continue to see advancements in hip arthroscopy in years to come.
How does the labrum function in the hip?
Dr. Hansen: The labrum is a little bit like a washer or a gasket. The hip is a ball and socket joint and about two thirds of the periphery of the socket there's this labrum. It has kind of a rubbery consistency, it also has a lot of nerve endings so when it's torn or pinched it hurts. The impingement occurs when the ball and socket joint pinch that labrum between the two bones.
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