Can you give me a little bit of background about yourself and your specialty?
I am a sports medicine specialist. In short, that means I typically operate on the shoulder, the hip, and the knee. From the perspective of treatment, as a sports medicine physician, I treat all issues. I see a broad spectrum of injuries from the head to the toes. I did subspecialty training in sports medicine and with hip arthroscopy, so that is one of my niche areas of expertise.
What type of injuries do you see specific to the hip in sports medicine?
I see sort of a broad range of injuries in various age groups. Everything from children who will have what are called avulsion injuries, or growth plate injuries, when they’re running, to arthritic injuries in older patients. In the middle, I see a lot of soft tissue injuries in the hip. The hip is a ball-and-socket, it has an “O” ring around it, if you will, called the labrum. I see injuries to that, those are very common.
Specific to the labral injuries, specifically those that would eventually have a hip scope, what treatment options do you offer, conservatively and then leading into surgery?
With most issues in the hip, we start with conservative management. Most of my patients will work with a physical therapist if they have an injury. Even a lot of traumatic injuries can get better with non-surgical care. With the help of therapists, we’ve developed a program for even something like labral tears. With that method, we’ve been effective in getting some patients better, but some still need surgery. We have a great Physical Therapy team here who works with us both before surgery trying to get patients better, and then after surgery if we do end up needing to operate.
How do you determine if you need surgery?
First of all, it depends on the patient. Whenever I sit down with the patient I try to find out what their objectives are. Some people’s objective is to run 10 miles every morning, and they can’t do that, so that’s something we have to negotiate. Other patients just want to get out of bed and go to work without pain in their hip. I always try to work with patients on their specific goals and if they’re not achieving their goals, we do whatever it takes to help them achieve that. In some cases we are working with very high-end athletes to get them back to where they need to be, and other patients will go to surgery simply because they can’t work with their hip issues. If we’re unable to make someone better with non-surgical and conservative treatments — anti-inflammatories, physical therapy, activity modifications — we often will discuss hip arthroscopy.
Hip arthroscopy is basically where we go in through a small hole with a camera so that we can see the hip joint. From there we can look at the damaged structures and repair them. I always tell patients, it’s a pretty easy conceptual treatment. It’s just going in and repairing that torn “O” ring, and then contouring a bump. That’s largely what we’re doing in the operation. Afterwards, we repair the opening that we made in the hip in order to get there.
Are there any technologies that have progressed over the past few years or that you see being crucial in the future?
Technology changes every year. It’s fun to be on the front end of that. We work with various companies to try to make hip scopes better. Every time that we finish a case, we think of a better way to do it. We do some mapping of a patient’s hip before surgery, that way we have a sort of geographic outline of the hip — the architecture, if you will. That way we know exactly where on the hip we need to address. That’s different than the standard MRI that we will do. The MRI will tell us if there’s a tear in the labrum, and where we need to fix it, but this is mapping of the hip so that we know how to restore the natural function of the hip. That has been exciting to use, it goes beyond the standard MRI. We also use a CT scan to create a kind of three-dimensional model of the hip and use that technology in the operating room to make sure that we have addressed the issue. Overall the tools and the technology that we use to do hip arthroscopy get better every year. We repair these labrums with something that is called an anchor. You might think of an anchor that holds the painting on a wall, but this is not metal, it’s a by absorbable material. There’s a suture coming out of it, which is how we repair that torn “O” ring down to the socket. That technology continues to evolve. We’re always coming up with new ways to make it a better operation and make it a better up here. It’s an exciting field because it’s constantly changing.
Do you need physical therapy after surgery?
As a surgeon that treats shoulders, hips, and knees, I always tell my patients I can scope your knee and you’re better relatively quickly, but You contrast that with the hip, and it’s a big operation in a small package. It’s only two little poke holes, but it’s still a long recovery. The therapy is really intensive afterwards. Sometimes it can be 3 to 4 months of therapy before you’re back on the field or doing the activities you’re used to doing.
Do you have any tips on prevention of hip injuries?
In general for most of the injuries that we treat in sports medicine, core strength is number one. A lot of these injuries that happen in the hip are due to an imbalance in the core muscles, the pelvic area, and the hip. In terms of overall prevention, we focus on that. Frankly, some patients don’t hurt necessarily, but they want to talk about prevention. From there we talk about a good, solid core strengthening program. This would be planks, side planks — we have a whole program for that.
Can you describe the comprehensiveness of the Bone and Joint Institute and how that helps the patient experience?
I think that’s the best part of where we work. We have our therapists 50 feet down the hall. Anything that’s going on with any of my patients in therapy, I have immediate communication about it. We also have our surgery center downstairs with our surgical team. We’re all sort of linked in together. It creates a more integrated experience for the patient. With all of the disciplines that we offer here, it makes for a comprehensive experience. It’s also just a family atmosphere. Our patients are family, as are our teammates.
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For more information about stress fractures, call Bone and Joint Institute of Tennessee at (615) 791-2630. You can also schedule an appointment online.