Hip Arthroscopy

I began my interest in hip arthroscopy when it was still a developing field in the early 2000’s. While I was training as a resident, I had the opportunity to observe Dr. Philipon, one of the original pioneers in the field, while he performed a live hip surgery.   Then, during my time at the Hospital for Special Surgery fellowship, I had the privilege to operate with one of the best hip arthoscopists, in Dr Bryan Kelly who helped me to gain a better understanding for the complexity and intricacies of hip preservation procedures. As I continued in my career, I was able to continue to develop my interest in the field by preforming the majority of hip arthroscopies on young, active duty military patients at Walter Reed. I have been happy to bring my experience and skills with hip arthroscopy to Inova to help our patients with hip pain make a full recovery and return to an active lifestyle.

Hip arthroscopy is a surgical technique that utilizes minimally invasive incisions, camera, and instruments to address intra and extraarticular problems of the hip joint. Frequently when a patient sees me in clinic for hip pain they also have previously been diagnosed with a labral tear. I tell those patients that labral tears are often signs of a larger problem known as Femoracetabular impingement (FAI), otherwise known as hip impingement. This is a problem where the ball is not perfectly spherical and/or the socket is not perfectly hemispherical and there is impingement of bone due to incongruity of the ball and socket.  The question patients ask me is “how did this happen?” I tell them it is likely a combination of how your hip developed and the type of activities you participated in growing up. I like to think of hip impingement as one end of the spectrum and hip arthritis on the other. If the impingement is fixed surgically by reshaping the bones to their anatomically normal shape, and by repairing the labrum, then patients continued cartilage damage and arthritis can be stopped before it is too late for arthroscopic repair.

As a hip arthroscopy specialist, I see a lot or referrals from other surgeons and physicians of patients who have failed previous hip surgery. Revision cases can be complicated and require time and patience to make the correct diagnosis and formulate a treatment plan that gives the patient  the best chance to get back to an active lifestyle. In patients where a labral repair has failed or in situations where hip pain is due to an irreparable tear of the labrum, I am experienced in the technically difficult surgery of labral reconstruction. Labral reconstruction is a surgical procedure which uses cadaver tissue to surgically replace the damaged labrum and restore the normal mechanics of the hip.  Anecdotally the success of this surgery has been a game-changer for my patients.

I am of the opinion that a lot of hip pain can get better with the right amount of activity modification and/or rest and working with a therapist to improve flexibility and improve strength around the hip, glutes and core.  I work with physical therapists, athletic trainers, chiropractors, primary care sports medicine specialists and many others to get to the root cause of patient’s hip pain. This team of specialists assist me in reducing patients’ hip pain with non-operative treatment and after surgery for those patients that undergo hip arthroscopy surgery. With this team approach to patient care, we can utilize a variety of different treatments including  injection therapy with corticosteroids, platelet rich plasma (PRP), and stem cells.

If pain persists despite my best effort to avoid surgery, I utilize the most cutting-edge technology to aid in pre-operative planning for surgery. If necessary, a 3D-computer generated mapping software is utilized to map out the bone deformity prior to surgery. I also utilize a variety of different technological advances at our two surgery centers which help me to provide the best care for our patients. In the operating room I use a post-less hip scope surgical table which has been shown to decrease nerve complications and pain after surgery and makes the surgery faster and safer. I also use intra-operative computer navigation program in the operating room which guides me to a precise and anatomic resection of the excess bone every time. This technology allows for an individualized guide while addressing the bony deformities intra-operatively. I repair and/or reconstruct the labrum and close the hip joint capsule at the conclusion of the surgery which has also shown to statistically improve patient outcomes. The surgery is a same day surgery and the patient recovers at home the night of surgery. I expect recovery to take 3-6 months depending on the condition and treatment  I am privileged to take care of patients with hip pain and I appreciate and can associate with his/her desire to return  to full activity as healthy, and quickly as possible. I will take the time to explain your hip condition to you with diagrams, models and imaging, I will answer all your questions with the time you deserve. Schedule an appointment today and see if I can help you on the road to a full recovery.