About 90% of the hip preservation work offered at Novant Health in Charlotte is hip arthroscopy.
“That’s the most accessible treatment and the most needed,” said Landry Jarvis, MD, an orthopedic surgeon at Novant Health who oversees the hip preservation program in Charlotte.
Hip preservation is a newer focus. It’s anything you can do up until the point where a patient needs a total hip replacement, which would limit that patient’s athletic abilities.”
Most arthroscopic procedures are focused on labral fixation and addressing impingement issues, or soft-tissue stabilization for people with instability issues. The Novant Health program also handles arthroscopic surgeries directed toward proximal hamstrings and gluteal tendon repairs.
Here’s what to know about Novant Health’s hip arthroscopy program.
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Patient referrals tend to be younger, from age 15 to 45.
“I have done surgeries on patients as young as age 15 — that’s really when labral tearing and impingement problems begin,” Dr. Jarvis said. “Generally, these patients have little to no arthritis and have been dealing with hip pain for two to three months.”
Ultrasound-guided injection is the key diagnostic test.
“Hip pathology is very complicated. We are able to know exactly what we are looking at by the time we recommend surgery,” Dr. Jarvis said. “The most important diagnostic test I do is an ultrasound-guided injection. When someone comes in, we need to identify if the issue is coming from their back, their hip joint, their hip flexor or the lateral space. I will put medicine in their hip joint under ultrasound, and I’ll re-examine them 15 minutes later. If their pain is at least 50% reduced, it’s a clear indication that the source of their pain is from inside their hip joint. If they don’t have arthritis and the source of their pain is inside their hip joint, then we point to labral pain and impingement.” The team will also order an MRI before surgery to check the condition of cartilage.
Hip arthroscopy can be a great option for younger patients as well as middle-aged patients who have minimal or no arthritis.
“For younger patients, such as college and high school athletes, and 30-year-olds who are active, it’s helpful for them to know their diagnosis,” Dr. Jarvis said. “Then if they go the hip arthroscopy route to fix it, they know they will be able to go back to all activities they want to pursue.
“For patients in their late 40s and early 50s who have hips that are starting to age but aren’t quite candidates for total hip replacement, I don’t want them to be in purgatory until they age enough and their hip degenerates enough to rationalize replacement. Arthroscopy gives them an option for pain relief.”
Patients with labral pain and impingement typically try nonoperative management before surgery.
“The nonoperative management is basically ibuprofen, avoiding impingement, avoiding sitting for long periods of time, avoiding high-flexion positions and then focusing on gluteal strengthening,” Dr. Jarvis said. “Thirty percent come back feeling good, and we follow them and see how things go. Seventy percent come back and say they are not where they want to be, so we take the surgical route.”
Surgery is outpatient and minimally invasive, with a post-less technique that mitigates the risk of nerve injury.
“There is about an hour and a half of actual surgical time, with three or four small incisions,” Dr. Jarvis said. “We make a hole in the capsule to get into the hip joint. We find the labrum tear and smooth out the bone behind the labrum. We usually repair the labrum with two or three anchors. And then we go over to the bony part of the femur and reshape that into a circular shape, so as the patient flexes their hip, they are not pinching their labrum anymore.”
Recovery is a process, but patients often reach their normal athletic capabilities after three months.
“We recommend physical therapy twice a week during recovery,”
Dr. Jarvis said. “Patients are usually in a brace and on crutches for three weeks. Most people feel like their normal sedentary selves in four to five weeks. People come in for their six-week visit, walking with no limp, and they generally hop up on the table feeling good. They can expect to be back to their normal athletic selves just after three months, and they can return to sports after four to five months.”
