A particular area of interest for Dr. Matthys is minimally invasive techniques to treat orthopaedic problems. He has devoted a great deal of time and energy on this increasingly prevalent topic.
Due to the increasing activity levels of our younger population, more and more hip injuries are being seen and diagnosed in adults under the age of 60. Historically, treatment for these conditions has required more invasive procedures. Hip arthroscopy allows us to treat various conditions with less pain and a more rapid recovery.
Some common problems treated by Hip Arthroscopy are:
- Labral tears
- Femoral Acetabular Impingement Syndrome
- Cartilage Tears
- Removal of foreign Bodies
- Early Osteoarthritis
Some of the more increasingly common injuries are tears of the labrum and femoral acetabular impingement syndrome. Labral tears have been treated in the past with trimming out the torn part of the labrum but Dr. Matthys prefers to try and repair the labrum instead of removing it. This restores the patient’s normal anatomy and gives them the greatest chance at preventing early arthritis or other problems with the hip in the future. Femoral Acetabular Impingement Syndrome is usually from a mis-shaped hip joint that can cause cartilage/labral damage, and hip pain if left untreated. This is treated with reshaping the hip to prevent the impingement of the femoral head on the hip socket (acetabulum).
Until recently, these procedures were done through large incisions. They required cutting the bone and dislocating the hip. However, Dr. Matthys has been trained in doing these procedures through minimally invasive surgery by using a small camera placed inside the hip joint. This is called Hip Arthroscopy. Arthroscopy is commonly performed on other joints, including the shoulder, knee, elbow, ankle and wrist. This minimally invasive approach decreases the patient’s rehabilitation time and also some of the complications associated with the larger open approach.
The instruments include an arthroscope, which is a long thin camera that allows the surgeon to view the inside of the joint, and a variety of “shavers” that allow the surgeon to cut away (debride) the frayed cartilage or labrum that is causing the pain. The shaver is also used to shave away the bump(s) of bone that are responsible for the cartilage or labral damage. Very similar to the knee and shoulder, small incisions measuring approximately 4mm are made to allow passage of the fiber optic camera and working instruments.
In addition to removing frayed tissue and loose bodies within the joint, occasionally holes may be drilled into patches of bare bone where the cartilage has been lost. This technique is called "microfracture" and promotes the formation of new cartilage where it has been lost.
In select patients, a small arthrotomy is made in front of the hip to repair structures as needed. This is considered an open procedure with an incision of about 3 inches.
The procedure is normally done as an “outpatient” surgery, which means the patient has the surgery in the morning and can go home that same day. Normally, the patient is under regional anesthesia. Under regional anesthesia, the patient is numbed only from the waist down and does not require a breathing tube.
What is the recovery time associated with hip arthroscopy?
Following the procedure, patients are normally given crutches to use for the first 1-2 weeks to minimize weight-bearing. A post-operative appointment is normally held 2 weeks after the surgery to remove sutures. Following this appointment, the patient normally begins a physical therapy regimen that improves strength and flexibility in the hip.
After six weeks of physical therapy, many patients can resume normal activities but it may take 3-6 months for one to experience minimal to no soreness or pain following physical activity. As no two patients are the same, regular post-operative appointments with one’s surgeon is necessary to formulate the best possible recovery plan.
Who will benefit from hip arthroscopy and what are the possible complications?
Following a combination of physical and diagnostic exams, patients are deemed suitable for hip arthroscopy on a case-by-case basis. Patients who respond best to hip arthroscopy are active individuals with hip pain, where there exists an opportunity to preserve the amount of cartilage they still have. Patients who have already suffered significant cartilage loss (severe arthritis) in the joint may be better suited to have a more extensive operation, which may include a hip replacement.
Studies have shown that 85-90% of hip arthroscopy patients return to sports and other physical activities at the level they were at before their onset of hip pain and impingement. The majority of patients clearly get better, but it is not yet clear to what extent the procedure stops the course of arthritis. Patients who have underlying skeletal deformities or degenerative conditions may not experience as much relief from the procedure as would a patient with simple impingement.
As with all surgical procedures, there remains a small likelihood of complications associated with hip arthroscopy. Some of the risks are related to the use of traction. Traction is required to distract and open up the hip joint to allow for the insertion of surgical instruments. This can lead to post-surgery muscle and soft tissue pain, particularly around the hip and thigh. Temporary numbness in the groin and/or thigh can also result from prolonged traction. Additionally, there are certain neurovascular structures around the hip joint that can be injured during surgery, as well as a chance of a poor reaction to the anesthesia.