So we’ve traveled from California to the UK to Missouri and now to Oklahoma for another Hip Preservationist perspective. Dr. Brandon Johnson from The Hip Clinic has agreed to share his perspective about hip preservation. Let’s begin this week’s focus from another expert who is able to provide a backdrop of hope for your hips!
Dr. Johnson has seen the biggest change in hip preservation in the last five to ten years due to the advent of labral reconstruction and the differentiation of gluteus medius repair techniques. When asked about exciting innovations coming down the pike in hip preservation, he is most “excited about image guidance for treating difficult impingement lesions as well as the growing understanding of gluteus tears and their treatment.”
Dr. Johnson also has some incredibly important advice for patients looking for a hip surgeon before you agree to any surgery. He says you should ask, “Are you a fellowship trained hip arthroscopist? How many hip arthroscopies have you performed?” This is because, per Dr. Johnson, there is “extensive analysis of surgical outcomes [that] show that patients of surgeons without fellowship training and experience (>500 arthroscopies) are 2-3X more likely to need a revision hip surgery.”
When looking for this type of surgeon, Dr. Johnson says that patients should make sure that the surgeon has “specific training [with] an arthroscopic fellowship with specific training in the hip. This includes exposure to approximately 100 hip arthroscopies during fellowship training.” There has been a substantial increase in hip arthroscopies and Dr. Johnson believes that this is because “there is more understanding of hip impingement and labral tears which has led to more diagnosis. The surgical equipment and technology has progressed to make these procedures more common.” Dr. Johnson does have some concerns for patient safety though because “there are more mid-career untrained surgeons that are starting to perform these procedures. Hip specialists like [him] recommend against untrained surgeons adopting these procedures.”
Dr. Johnson also shared that his “goal is to always repair the labrum. [He] only debrides the labrum if it is deemed irreparable. “[He} only perform[s] labral reconstruction in a revision setting. Meaning the patient has either had a prior debridement or failed a prior repair.” Patients in the revision setting are, according to Dr. Johnson, “the biggest challenges [he] face[s] [because they] have failed prior hip arthroscopy with another surgeon. MR imaging isn’t perfect, particularly in a postoperative hip. So often times in a revision setting [he has] to be very adaptable intraoperatively. The ability to reconstruct the entire labrum has definitely standardized this problem. However, it is still very challenging.”
Dr. Johnson also has insights to the recovery process including choosing your Physical Therapist to taking on responsibility for your rehab outcomes. Dr. Johnson suggests that you ask your prospective PT if he or she “has experience rehabilitating hip arthroscopy patients? Many therapists have rehabilitated hip replacement patients. Much fewer have rehabilitated arthroscopic patients which is completely different.”
He also understands that “rehabilitation is the hardest piece in hip recovery. Successful patients take ownership of their rehab and integrate what they learn from their therapist into a personal regimen that they keep up with. Patients that are aware of their ideal body weight and work to stay in that range have better results.”
Dr. Johnson is proud to be a hip preservationist and when asked what he was most proud of he provided two answers. Number one, he is “most proud of [his] work advancing labral reconstruction. [He] was the first surgeon in Oklahoma to perform an arthroscopic complete hip labral reconstruction. Annually [he also teaches] an advanced labral reconstruction course in Denver.” Secondly, he takes great pride when his patients have successes after surgery. He states, “I am most proud of my labral reconstruction patients. Patients that have failed prior surgeries can be very difficult to treat. However, I am most proud when a patient comes to me having failed a prior procedure and we are able to get them back to functioning without pain.”
For further information about Dr. Johnson’s hip preservation practice, please check out his website! Here’s to healing hips!