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Hip Arthroscopy: Then and Now


I had my first hip surgeries (3 to be exact) 11 years ago and two recent revisions in 2018! Things have definitely grown up in the world of hip preservation and hip arthroscopy.



Here is my bird’s eye view of then and now! My one constant has always been to make sure I ask questions.





2008


  • There were only a few highly qualified surgeons performing hip arthroscopy.

  • Most insurance companies considered it experimental. There were only two or three codes that could be used to get the soft tissue surgery approved (ie. no bone work)

  • Doctors only debrided or repaired the labrum.

  • Surgeons were not closing the capsule as a routine.

  • Surgeons were not removing impingements as aggressively or with today’s accuracy.

  • Doctors routinely used a torture device called a perineal post.

  • Very few laymen knew what a hip scope was and the standard response I got was, “You are too young for hip problems.”

  • The standard post-op equipment was crutches.

  • There were no protocols for physical therapy and rehab.

  • There were Yahoo Groups of patients.


Now


  • There are Fellowship programs in Hip Preservation. There is now research on the learning curve of the training required to perform Hip Preservation surgeries. More extensive surgeries are being done with minimally invasive techniques.

  • Most insurance companies will pay for it after conservative treatment. Although one company has deemed it not covered if you are over 50 despite the research contrary to this policy.

  • Debridement of the labrum is typically the least favored option as compared to repair and reconstruction of the labrum.

  • Surgeons understand the potentially devastating consequences of not closing the hip capsule after a scope.

  • Surgeons use 3D CT scans to make sure they have a good pre-op plan to resect all of the impingements.

  • The perineal post has been shown to cause nerve related problems and many hip surgeons are no longer using it.

  • More laymen know what hip scopes are, but will still say, “You are too young for hip problems.”

  • Post-op equipment ranges from crutches to CPM machines to braces and ice machines (no bags of peas post-op)

  • Hashtags, Facebook and social media connect hip patients from all over the world.



Food for Thought!

1. Make sure your chosen doctor is appropriately trained. Fellowship trained is ideal.

2. A good place to start to find a doctor is the International Society for Hip Arthroscopy.

3. Second and third opinions can be necessary.

4. Make sure your surgeon has the ability to do all of the more extensive hip preservation procedures.

5. Look forward to Hopeful Hips!

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