Arthroscopy (also called Arthroscopic surgery) is a surgical procedure by which the internal structure of a joint is examined for diagnosis (and possibly treated) using an instrument called an arthroscope. Arthroscopy gives doctors a clear view of the inside of a joint, and helps them diagnose and treat joint problems. Hip arthroscopy has been slower to evolve than arthroscopy of other joints such as the knee or shoulder, mostly because the hip joint is much deeper in the body and therefore harder to access, but can be very effective at treating certain hip conditions.
Arthroscopic hip surgery is radically different than traditional open surgery, and may be considered before one opts for a full hip replacement surgery. Non-operative measures should always be considered first — rest, behavior modification, physical therapy and anti-inflammatories may work to alleviate reversible disorders. If non-operative measures aren’t effective and you do elect for surgery, a procedure may be done arthroscopically instead of by traditional surgical techniques, as it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.
Did you know spine surgery can now be done with only a small incision? Minimally invasive spine surgery is a relatively new set of techniques that has opened up surgery as an option for people who might otherwise have continued to suffer without surgery.
Patients often have the preconceived notion that spinal surgery will put them in bed and unable to walk for a long period of time. The fact is most spinal surgery does not lead to such a disabled state. And with minimally invasive surgery, patients can get back on their feet, out the hospital, and back to their normal routine faster than they’d ever have thought possible.
Cynthia Burnett is a great example of a patient who’s had minimally invasive spine surgery at Emory with excellent the results. In 2008, 56-year-old Cynthia Burnett woke up one day with excruciating nerve pain down her leg. Over the next two years, she suffered with this pain, despite multiple epidural injections. The pain just would not go away, even with the best non-operative treatment. Cynthia said she felt as if she’d aged 10 years. Her daughter recommended she come to Emory, where Cynthia saw one of our physiatrists, a nonsurgical physician who specializes in diagnosing and treating spine pain. He diagnosed a spinal stenosis (nerve pinch) and a slippage of one of her vertebrae on another. After careful analysis and discussions of options, she was told she’d be a good candidate for surgery. That’s when Cynthia came to me to discuss the surgical option.
At first, Cynthia didn’t want surgery. She said later, “My big concern about having surgery was the invasiveness. I’m healthy. I don’t go to the doctor very much. I haven’t been very sick. I just really didn’t want to choose to go under the knife.”
While not all cases can be treated with minimally invasive techniques, Cynthia was a great candidate for minimally invasive surgery. If this had not been the case, we could have used a traditional surgical technique with good results. But it would have required using, a relatively large incision to visualize the problem areas of the spine, thus a longer recovery time.
VIDEO: Cynthia’s Story of Minimally Invasive Spine Surgery
Instead, with Cynthia, we used highly specialized retractors that are placed through small incisions with X-ray guidance to minimize the soft tissue damage. Through these small incisions, the spinal nerves were decompressed (“unpinched”), and the slipped vertebra was stabilized with a spinal fusion procedure. The factors that enabled me to do this include advanced surgical instruments, advanced imaging systems (three-dimensional computer-guided navigation), and years of surgical experience. These things lead to surgical results that are safer, less invasive, and more reliable than ever before.
Cynthia had the surgery December 16, 2010. Afterward, she said, “It was amazing to me how easy it was to walk around, and my nerve pain was gone immediately.” Cynthia also said, “It’s amazing to think they could do that with the small incision that I have. I wish I had done it years ago. And I’ve already told other people who are in pain, you need to go.” She was truly thrilled. At Emory, our goal is to get patients back to health as quickly as possible. That’s what minimally invasive surgery is all about.
About S. Tim Yoon, MD: S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and is assistant professor of orthopedic surgery and chief of Orthopedics at the Veterans Administration Medical Center at Atlanta. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.
When I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.
Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.
Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.
While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.
“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”
Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.
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