I’ve had the privilege of sharing with you, through my hip journey, some of my lessons learned from Dr. Robert Kollmorgen, but this blog post is getting down to the nitty gritty of hip preservation from his set of lenses. Dr. Robert Kollmorgen is an amazing patient- centered physician who also has the technical skills to meet the needs of hip patients in Central California and beyond.
I queried Dr. Kollmorgen as I wanted to incorporate a point of view about hip preservation from a doctor who is personally helping me preserve my own hips! So here are his responses to my Hopeful Hippie inquiring mind questions!
From your perspective, what are the biggest changes in hip preservation in the last 5-10 years?
There are many changes in this area. Hip preservation procedures are one of the fastest growing fields in Orthopedics. [Changes include] the concept of labral repair over debridement, capsular preservation and repair, indications for labral reconstruction, and patient selection for a durable PAO [periacetabular osteotomy].
What do you see as the reason for the increase in hip arthroscopy?
Since Dr. Ganz introduced the world to FAI, surgeons in the last 20 years have striven very hard to advance the field. As with any "new" operation surgeons have advanced and created techniques and we continue to work on establishing long term outcomes.
How do you see hip preservation being practiced in the U.S. as compared to other countries?
Thankfully, this field is evolving together globally. The UK study showing the efficacy of FAI surgery compared to PT agrees with the U.S. RCT (Randomized Controlled Trials). The concepts of creating proper shape, labral repair, and capsular closure are global. Advanced techniques of labral and capsular reconstruction are based on graft availability and surgeon skill, but are evolving.
What are some exciting innovations coming down the pike in hip preservation that you would like to see further research in the United States?
Cartilage repair biologics would be exciting to get approved in the US.
What is the one of the most important questions that patients should ask of their prospective surgeon prior to agreeing to surgery?
There are many questions I would ask to gain comfort with my surgeon. Have you treated patients with my problem? How often do you treat this? Do you have advanced training in my surgery? What are the published outcomes? What are your outcomes?
What type of surgeon training should patients look for when choosing a surgeon?
For hip preservation, I would ask if the surgeon is fellowship trained in Hip Preservation. Where? Did the training involve my surgical issue?
When picking a PT for post-op rehab, what types of questions should a patient ask a prospective PT?
I think PT is all about relationships. The patient and therapist have to be on the same page. Ideally a therapist that knows the procedure and rehab protocol. Some of my patients live in rural areas and have one option. The surgeon should be in touch with the therapist so the whole team is on the same page.
When would you do a labral debridement versus repair versus reconstruction?
Debridement is in select cases where the chondrolabral junction is intact, no wave sign and labrum is well fixed but frayed, and the cam lesion is only to blame. This is rarely the case and most of my patients have labral repairs. Reconstruction is a salvage surgery and utilized in revisions and I do consent all my patients in case the labrum, at primary FAI surgery, is not viable. Again, reconstruction is a rare case and should be considered as a last resort.
How can a patient contribute to the success or failure of their results?
Healing is patient specific. Some cope well with pain and others need more time. Following a specific protocol, NO limping, and time. This surgery takes time to heal and regain strength.
Why are there such varied protocols related to weight bearing status, and range of motion restrictions?
Many surgeons and physiotherapists have their own take on rehab. The exact procedure, area of repair and capsular management dictates the protocol and aggressiveness. Each surgeon has their own reasons.
What are you most proud of as far as your contribution to the field of hip preservation?
For our group, we have contributed post free distraction utilizing a standard hip distraction table. We have eliminated groin, perineal and pudendal nerve injuries that are caused by utilizing a large [perineal] post during surgery.