Orthopedic Hip & Knee

Anterior Approach Hip Surgery

Hip replacement surgery has historically been performed using a posterior-lateral approach, with the patient facing downward. The surgeon would need to make incisions into the large muscles of the pelvis or femur (thighbone) to access the hip joint. This type of procedure required larger incisions and caused associated pain. Patients faced longer recovery times and potential joint instability due to the nature of the surgery.

Our team uses a specially designed operating table that enables the surgeon to perform hip replacement surgery using an anterior approach, with the patient facing upward. Using this less invasive approach enables surgeons to replace the hip joint by working through the natural interval between muscles, using smaller incisions on the front of the upper thigh and without cutting into or detaching the important muscles at the side or back of the leg.

This approach enables surgeons to manipulate the leg more easily during surgery so they can properly position and evaluate the movement of the new hip joint. It allows for X-rays to be taken during surgery, further ensuring proper fit, leg length and optimal placement of hip joint components.

Benefits of the Anterior Approach

Because the surgeon moves muscles aside to access the hip joint, all muscles and natural stability are preserved. There are smaller incisions, and less blood loss and scarring. Since the incision is in front, patients avoid the pain of sitting on the incision site. Like similar minimally invasive procedures, this may decrease the average hospital stay to just two to four days. Patients can return to an active lifestyle more quickly.

Direct Superior Approach

The direct superior approach allows the orthopedic surgeon to spare muscles and tendons more than any other approach in town, primarily the piriformis muscle and the iliotibial band, which are not disrupted. The advantage is post-operatively, there are no hip precautions to avoid in case of dislocation, which you have to avoid in other approaches. Also with the minimal muscle disruption, you have less pain and get back to activities faster, needing less pain medicines, and rarely do you even need physical therapy after surgery.

Hip Pain

Living with painful, popping hips? Because the hip joint is the deepest in the body, and one of the most complex, diagnosing and treating this kind of pain can be challenging.

It’s often experienced by people under age 50 due to a sports or occupational injury, but it can also occur from normal wear and tear and mechanical/physiological abnormalities.

Treatment often starts with nonsurgical nonsteroidal medications, cortisone shots and physical therapy. When those do not bring relief, patients may be told nothing more can be done.

Unfortunately that means learning to live with pain that also decreases your ability to be active.

Diagnosis and Treatment through Hip Arthroscopy

Seeing an orthopedic surgeon who performs hip arthroscopy, a newer and highly specialized procedure, can result in definitive diagnosis and treatment of many painful hip conditions, including:

• Hip labral tear – Tear in cartilage around the hip socket
• Hip impingement – Pinching from irregular shape of hip bones Hip bursitis – Inflammation of fluid-filled sacs that cushion bones Loose bodies – Fragments of cartilage caused by injury
• CAM lesion – Extra bone on the head of the femur
• Snapping hip syndrome - Type of tendinitis caused by repetitive physical movements
• Synovitis – Joint lining inflammation that causes swelling

While arthroscopy has long been used for the knee and other joints, it is not commonly used for the hip due to the depth and shape of this joint. Relatively few orthopedic surgeons have focused their training to perform this highly specialized procedure.

Evaluation of Hip Pain

Because of the complexity of hip pain, diagnosing the cause can take time. It’s important to determine if the source is the hip, back or an intrapelvic problem.

Diagnosis starts with a thorough exam. An MRI is also often needed. A diagnostic injection may be performed to confirm the source of pain. This involves injecting numbing medicine and an anti-inflammatory into the joint. Experiencing temporary relief confirms the source of the pain.

Hip Arthroscopy Procedure

Hip scope or hip arthroscopy is a minimally invasive procedure, meaning it requires only a small incision and you can usually go home the same day.

• The orthopedic surgeon makes small ¼-inch incisions close to the hip and injects fluid to keep the joint open.
• A guide wire and then a small tube are inserted into the joint. An arthroscope with a microscopic camera goes through the tube into the joint.
  
• The tiny camera provides a view of the hip joint on a large monitor so the surgeon can identify the problem area.
• If the problem area or damage can be repaired, the surgeon will make additional small incisions to insert surgical tools.
• The instruments are then removed and the small incisions are closed.

The entire procedure can take two hours or less and involves one to four incisions. The advantages of this approach include less tissue damage, pain and scarring.

Risks of Hip Arthroscopy

Because this procedure is minimally invasive, the risks are generally lower than with open procedures that require a large incision and may include:

• Incision-site infection
• Tingling around the incisions
• Damage to hip, groin or thigh nerves or blood vessels
• Incomplete resolution of pain

Recovering from Hip Arthroscopy

Most patients go home the same day using crutches to keep pressure off the hip. Recovery over the next six weeks may include physical therapy as you return to bearing weight on the hip. Full recovery and a return to normal activity can take six months.

Are You a Candidate for Hip Arthroscopy?

CHI Health has an orthopedic surgeon who specializes in this procedure. The first step is a thorough assessment of your pain. Call CHI Health Orthopedics at (402) 717-0820 to make an appointment today.

Is chronic knee pain slowing you down? The orthopedic surgery experts at CHI Health are here to get you moving again. Our Joint Replacement Center has been recognized as a center of excellence, with many of our facilities demonstrating better overall quality of care and superior outcomes. 

Through every phase of your journey, count on personalized care that includes:

• Pre- and post-surgery education
• Dedicated patient care unit
• Focused care from specially trained staff
• Joint Care Manager who will coordinate your care
• Group physical therapy
• Patient education videos and printed materials
• Assistance in choosing the best rehabilitation option for you after discharge
• Shorter length of stay – typically three days

What You Can Expect from Knee Replacement Surgery

Before you have knee surgery, the Joint Replacement Center will make sure you’re thoroughly prepared to achieve the best possible outcome. First, you will take part in a class in which you will tour the facility, learn what to expect of the surgery, as well as the recovery and rehabilitation process, and find out when you can return to your daily activities. 

As a supplement to the live class, we also encourage you to view knee replacement surgery educational videos we’ve created to help you prepare for your procedure with confidence.

Your Recovery and Rehabilitation Process

Most knee surgery patients are able to return home immediately after their stay at the Joint Replacement Center. You may also be referred to CHI Health Home Care or a transitional care unit. 

Whatever the case, we will make sure you have access to all of the resources you need, including nursing, home health aides, and physical and occupational therapy. If you need additional assistance, a social service/case manager will help arrange for home healthcare, outpatient therapy, or placement in a skilled nursing facility or acute rehabilitation center. 

After you leave the Joint Replacement Center, you will be given detailed information and instructions for exercises to do at home to aid in your rehabilitation. We will also give family members detailed instructions on how they can assist in your recovery at home. Depending on your unique needs, you may also be referred to a CHI Health Physical Therapy Clinic.

Are You a Candidate for Knee Replacement Surgery?

Find an expert orthopedic surgeon at CHI Health to see if the procedure may be right for you.

About Knee Arthroscopy

Knee problems often can be diagnosed and treated with a technique called arthroscopy. This type of surgery is done using an instrument called an arthroscope (scope). Only a few small incisions are needed for this surgery. The procedure can be used to diagnose a knee problem. In many cases, treatment can also be done using arthroscopy.

The arthroscope

The scope allows the doctor to look directly into the knee joint. It is about the size of a pencil and contains a pathway for fluids. It also contains coated glass fibers that beam an intense, cool light into the knee joint. A camera is attached to the scope as well. It provides clear images of most areas in your knee joint. The doctor views these images on a monitor.

Preparing for the procedure

• Have lab or other testing done as advised.
• Tell your doctor about any medicines or supplements you take
• Your doctor will tell you if you need to stop medications, food or drink prior to the surgery.
• Once you arrive for surgery, you will be given an IV line in your arm or hand. This provides fluids and medicines.
• To keep you free of pain during the surgery, you’ll receive medicine called anesthesia. You may have:
  • General anesthesia. This puts you into a deep sleep during the surgery.
  • Regional anesthesia. This numbs the body from the waist down.
  • Local anesthesia. This numbs just the knee.

In addition to regional or local anesthesia, you may receive sedation. This medicine makes you relaxed and sleepy during the surgery.

The procedure

• A few small incisions (portals) are made in your knee.
• The scope is inserted through one of the portals.
• Sterile fluid is put into the knee joint. This makes it easier to see and work inside your joint.
• Using the scope, the doctor confirms the type and degree of knee damage. If possible, the problem is treated at this time. This is done using surgical tools put through the other portals.
• When the surgery is done, all tools are removed. The incisions are closed with sutures, staples, surgical glue, or strips of surgical tape.

Call (402) 717-0820 for more information about arthroscopy.