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Table of Contents:
Hip Anatomy and Disorders
Possible
Treatment Options
• Non-Operative Treatment
of Hip Pain
•
Hip Arthroscopy
•
Hip Arthroscopy Complications
Successful Outcomes
Recommended
Reading for Further Information
Frequently
Asked Questions
•
Who is Dr. Hal Martin?
•
What is OSSO?
•
What does The Hip Clinic at OSSO offer?
•
Can hip arthroscopy help me?
•
What are the benefits of arthroscopy?
•
What are the goals of hip arthroscopy?
•
Where is the Hip Clinic located?
•
What makes The Hip Clinic unique?
Hip Anatomy and Disorders
The hip is
a large, weight-bearing, ball and socket joint. The acetabulum is the
"cup" portion of the pelvis where the head of the femur sits.
When engaging in routine activities, approximately three times the body
weight is distributed through the hip due to muscle pull and joint
forces. If a degenerative condition exists within the hip, the
biomechanical relationship will be altered and can cause limping, leg
length inequality and disability. This ball and socket joint has a high
degree of fit and stability. The stabilization of the joint comes from
strong ligaments, muscles, and bony contour (including the acetabular
labrum).
If unequal distribution is causing excessive wear to the joint, restoring
stability in the joint can redistribute the load force. Research has
shown that the labrum acts as a suction seal in the hip. If this is torn,
it is possible for rapid progression of degenerative arthritis to occur.
FAI (femoroacetabular impingement) is a commonly recognized source of hip
pain and can be associated with labral tears which can precipitate
softening of the cartilage. Physiologic preservation is possible through
hip arthroscopy. Early diagnosis is the key for arthroscopy to be a
treatment option. Unfortunately, many hip disorders are misdiagnosed as
back problems; therefore, a thorough physical exam is vital. It is often
followed by an MRI arthrogram, which is an MRI preceded by a dye
injection, which can reveal up to ninety percent of the pathology within
the hip. Other common hip disorders include Impingement, snapping hip,
ligamentus laxity, and tendonitis, to name a few. With a thorough
evaluation, these disorders can be diagnosed and the most up-to-date
treatment options provided.
Potential Causes of Pain:
Extracapsular:
· Tendonitis
· Bursitis
· Avulsion Injury
· SIJ Strain
· Myositis Ossificans
· Neurologic Etiology
Intraarticular:
· Stress Fracture
· Osteonecrosis
· DJD
· Loose Bodies
· Labral Tears
· Ligamentum Teres
· Impingement
· Chondral Injuries
· Instability
· Capsular Strain back to
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Possible Treatment Options
• Non-Operative Treatment of Hip Pain
Early
onsets of hip pain may benefit from conservative treatment. This
treatment could include anti-inflammatory medications, exercise, physical
therapy, and weight loss.
Proper diagnosis through physical examination is essential to successful
treatment.
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• Hip Arthroscopy
In the past
there have been few treatment options for hip disorders. New techniques
and instrumentation have contributed to facilitate the treatment of hip
disorders by hip arthroscopy. Dr. Martin offers hip arthroscopy, which is
a minimally invasive procedure using small incisions and pencil sized
instruments to repair damage in the hip. A small camera is placed into
the hip joint through a 1⁄4-inch incision. This allows the surgeon
to visualize the hip surface. A second small incision allows other
surgical instruments to be placed into the joint. A few of the advantages
of this minimally invasive surgery are less pain, less bleeding, less
scarring and a quicker recovery. The hip, where the femoral head (ball)
sits deeply in the socket, makes surgical access significantly more
difficult than the shoulder or knee, which have more room for the
arthroscope and surgical instruments. Because of this procedure’s
technical demands, it requires significant training and practice. Through
hip arthroscopy we can alter the course of the degenerative condition
postponing the need for hip replacement or even eliminating it all
together. Dr. Martin has performed or assisted in this surgery on over
750 patients. The procedure is outpatient followed by a carefully
designed rehabilitation program; twelve to sixteen weeks are required for
full recovery. Potential candidates are active individuals who have
painful hips. An exam and x-rays will help determine candidates along
with an MRI arthrogram.
Benefits
Hip Arthroscopy offers a less invasive alternative for traditionally
recognized forms of hip pathology. Arthroscopy also offers a method of
treatment for many conditions (including, but not limited to, labral
tears, impingement, acute articular injuries, and damage to the
ligamentum teres) that previously went unrecognized and untreated. In the
past, these patients were simply resigned to living within the
constraints of their symptoms and eventually undergoing a total hip
replacement. With the recent advent of improved surgical techniques,
advanced imaging modalities, and more versatile instrumentation, hip
arthroscopy can now be performed safely and effectively as an outpatient
procedure. Ninety percent of patients having undergone hip arthroscopy
have good or excellent results.
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• Hip Arthroscopy Complications
As with all
surgical procedure, there are risks and the possibility of complications.
1. Traction- induced and compression neuropraxia. The hip joint requires
greater traction on the limb than other arthroscopic procedures; this
increases the risk for neuropraxia. They are usually temporary, resolving
in a few days. Careful attention to positioning and padding, plus surgery
time, helps to decrease the incidence of these neuropraxia.
2. Fluid Extravasation: Fluid can extravasate into the perineum, thigh,
and abdomen. This is rare, but cases have been reported. Close monitoring
of outflow and fluid volume can help to decrease this risk.
3. Iatrogenic Intraoperative Complications: Perforation and damage to the
labrum can occur if portal placement is not accurate. Manipulation of the
instruments in the small deep joint space or poor arthroscopic technique
can lead to damage to the articular cartilage. A highly skilled surgeon
with extensive hip arthroscopy experience can minimize this risk.
4. Post-op Complications: As with any surgery, infection is a risk, but
is rare. Antibiotics are given post-operatively to help lower this risk.
DVT is a potential post-operative complication. A blood thinner is given
for ten days post-op to lower this risk.
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Successful Outcomes
Strict
attention to thorough diagnostic examination, detailed imaging, and
adherence to safe and reproducible surgical techniques are essential for
the success of hip arthroscopy.
The following are quotations we have heard from our hip arthroscopy
patients:
"I have not had one minute of pain since my surgery."
"I am amazed at the results."
"I have been to 10 doctors and no one could find out what was wrong
with me until now."
"I've been in excruciating pain for three years and had immediate
pain relief post-op."
"I kept telling the doctors it was my hip that was hurting and they
kept treating my back."
"I had not been able to run without pain for over eighteen months
and am now able to run 3-4 miles without pain."
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Recommended Reading
for Further Information
Byrd, J.W.
Thomas: Hip Arthroscopy. Clinics in Sports Medicine 20(4): 703-747, 2001
Byrd, J.W. Thomas: Osteoarthritis caused by an inverted acetabular
labrum: radiographic diagnosis and arthroscopic treatment. The Journal of
Arthroscopic and Related Surgery18(7): 741-747, 2002
Ferguson, S.J.
et al: An in vitro investigation of the acetabular labral seal in hip
joint mechanics. Journal of Biomechanics 36: 171-178, 2002
Ferguson, S.J.
et al: The influence of the acetabular labrum on the hip joint cartilage
consolidation:
a poroelastic finite element model. Journal of Biomechanics 33: 953-960,
2000
Griffin, D.R.,
and Villar, R.N.: Complications of arthroscopy of the hip. The Journal of
Bone and Joint
Surgery 81(4): 604-606,1999
Kelly, Bryan
et al: Hip arthroscopy: current indications, treatment options, and
management issues.
The American Journal of Sports Medicine 31(6): 1020-1037, 2003
McCarthy, et al: Anatomy, pathologic features, and treatment of
acetabular labral tears. Clinical
Orthopaedics and Related Research 406: 38-47, 2003
Philippon, Marc J.: Debridement of acetabular labral tears with
associated thermal capsulorrhaphy.
Operative Techniques in Sports Medicine 10(4): 2002
Philippon, Marc J: The role of arthroscopic thermal capsulorrhaphy in the
hip. Clinics in Sports Medicine 20(4): 817-829, 2001
Sampson, Thomas G.: Complications of hip arthroscopy. Clinics in Sports
Medicine 20(4): 831-835, 2001
Tonnis, D et al: Acetabular and femoral anteversion relationship with
osteoarthritis of the hip. The Journal of bone and Joint Surgery
81-A(12): 1747-1770, 1999
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Frequently Asked Questions
• Who is Dr. Hal Martin?
Dr. Hal
Martin has been serving patients as an orthopedic surgeon for over
thirteen years. Dr. Martin recently completed a fellowship in sports
medicine, hip arthroscopy and disorders at the University of Pittsburgh
Medical Center in Pittsburgh,
Pennsylvania. There he
assisted as a consultant for professional athletes including NFL, PGA,
LPGA, and NHL players as well as athletes of all levels. Dr. Martin is
now the director of the Hip Clinic with Oklahoma Sports Science and Orthopaedics
in Oklahoma City
and is passionate about continuing the research and development to
discover new options for the treatment of hip disorders.
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• What is OSSO?
OSSO stands
for Oklahoma Sports Science and Orthopaedics which was started by Dr.
Calvin Johnson in 1993. OSSO offers a comprehensive orthopedic practice
with specialists in many areas including hand surgery, spine surgery,
arthroscopic surgery, physical medicine, sports medicine, etc. The staff
and physicians of The Physicians’ Group are dedicated to providing
the highest quality, state-of-the-art and cost effective services needed
to nurture the physical, spiritual and emotional health of their
patients.
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• Can hip arthroscopy help me?
Possible
candidates for hip arthroscopy are active individuals who have painful
hips. An exam and x-rays, along with an MRI arthrogram, will help
determine a need for this surgery.
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• What are the benefits of arthroscopy?
The
benefits of hip arthroscopy include decrease in pain, scarring, and
bleeding. Arthroscopy also requires less time in a hospital as it is an
outpatient surgery and shorter time for recovery. Early, accurate
diagnosis and treatment can lead to less invasive treatment and quicker
return to a normal, active lifestyle.
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• What are the goals of hip arthroscopy?
The main
goal of hip arthroscopy is to take a patient living in pain and unable to
participate in desired activities and return them to their highest
quality of life and maximum level of activity. Another goal is to stop
the progression or onset of osteoarthritis which could one day lead to a
need for total hip replacement.
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• Where is The Hip Clinic located?
The Hip
Clinic sees patients at St. Anthony North/Oklahoma Sports Science and
Orthopaedics which is located at 6205 N. Santa Fe in Oklahoma City. On the first floor of
our building is a state-of-the-art Ambulatory Surgery
Center and the OSSO
clinic is located on the second floor. For your convenience, not only do
we have the surgery center and clinic in the same building, the building
next door houses an open MRI and a physical therapy clinic.
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• What makes The Hip Clinic unique?
The Hip
Clinic at OSSO offers the newest alternatives in treatment of hip
disorders. The Hip Clinic is focused on treatment options to improve
patient’s quality of life. Treatment options are research based,
proven successful and are provided by a fellowship trained surgeon in
sports medicine/hip disorders.
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