By Laura Freeman
As an alternative to open surgery, minimally invasive hip arthroscopy has greatly advanced the repair of hip injuries. However, the need to gain access by using a post for counter traction to distract the joint and hold the leg in place for an extended period can result in pressure injuries. Tissue damage can range from hematomas to full-blown pressure necrosis and may involve the scrotum or labia majora.
“The ball and socket joint in the hip is very deep. It takes a great deal of force and skill to distract it safely,” Aaron J. Casp, MD said. An assistant professor of orthopedic surgery in the division of sports medicine at UAB’s Heersink School of Medicine, Casp is one of the first surgeons in the region who performs a new postless hip arthroscopy procedure.
“Over the past year we’ve been using a new technique that eliminates the need for the traditional post setup,” he said. “During the procedure the patient lies on a traction bed and we position a device similar to a memory foam pad along the inner side of the leg. This allows us to distribute the force over the full length of the device, which reduces the pressure on any one area.”
The surgeon makes two small incisions to introduce the arthroscope and a 70 degree camera. In addition to preoperative MRI imaging, the camera allows visualization of the joint and injury as well as cartilage fragments, chips and other debris that may be responsible for symptoms.
“Labrum tears are the most frequent injury we see,” Casp said. “Many of our patients are athletes ranging in age from high school to 45. The injuries tend to occur during sports or other leisure or work activities. Motions that cause hyperflexion or an acute twist or pivot of the join can cause tears. Repetitive use can also cause extra bone to build up on the ball side and lead to problems.
“Arthroscopy allows good visualization, so we can see exactly what is going on and what we need to do to repair the joint and ease symptoms. We repair tears by using suture anchors to bring the labrum up on the bone. Then we remove any debris that might be a problem and reshape the bone if needed.”
Usually an outpatient procedure, postless hip arthroscopy patients can go home the same day. They will typically be on crutches for around four weeks and are usually released to return to their favorite sports and activities in about five months.
Postless arthroscopy can also be used to help patients over the age of 45, however excessive cartilage damage that may have built up over time could limit the results that can be expected.
“When cartilage damage is extensive, I may have to advise an older patient that they could be facing a hip replacement in the future,” Casp said.
Based at UAB’s Heersink School of Medicine, Casp performs the procedure at UAB and St. Vincent’s surgery center. The new approach offers definite advantages in reduced risk of pressure injuries. As of now, the postless option is so new that Casp is among the few, if not the only surgeon in the area, who performs it, and referrals are coming in from across the region.
“There’s a long learning curve for this procedure,” he said. “It’s very technical, uses some new, longer instruments and requires a lot of practice to become adept. However, several of my students are surgical residents who are working with me and learning the postless hip arthroscopy procedure. It should soon become a more widely available option to help many more patients.”