New Hip Arthroscopy Technique Can Mean Less Pain, Complications

A new surgical technique can help patients undergoing arthroscopic hip surgery avoid numbness in the genital area – a complication that occurs in up to 25 percent of patients undergoing the procedure.

Your doctor may recommend arthroscopic surgery if you have a hip joint pain that does not get better after treatments such as rest, physical therapy and medications.

Arthroscopy is a minimally invasive procedure in which the surgeon inserts a small camera, called an arthroscope, into your hip joint. The surgeon guides miniature surgical instruments with the help of live camera images displayed on a video monitor.

Arthroscopy is used to treat labral tears, femoroacetabular impingement and other hip joint issues. Hip impingement, in which there is abnormal and wearing contact between the ball and socket of the hip joint, is a significant source of pain and missed time for athletes in sports such as hockey, running, dance, soccer and football.

An increasing number of high-profile athletes have undergone arthroscopy to quicken rehab time and return to action sooner.

Risks of Hip Arthroscopy

With traditional arthroscopy, patients often face a long rehabilitation and post-surgical pain, says orthopedic surgeon Michael Salata, MD. Dr. Salata is Director of the Joint Preservation and Cartilage Restoration Center at University Hospitals Cleveland Medical Center and Associate Team Physician for the Cleveland Browns.

“When we do hip arthroscopy, we need to open the joint up so that we can safely pass our instruments into the joint,” Dr. Salata says.  “The traditional way to do that is to pull traction on the leg and to place a large padded post in the patient’s perineal area to provide counter-traction.”

In addition, there is a risk of temporary or permanent numbness in the genital area, Dr. Salata says.

“Possible hip arthroscopy complications also include urinary retention, increased post-operative pain, retrograde ejaculation and erectile dysfunction,” Dr. Salata says. “In some of the published literature, the genital numbness has been reported to occur as high as 16 percent to 25 percent of patients.”

The new surgical approach Dr. Salata has pioneered virtually eliminates these complications.

Improved Safety

There has been a rapid increase in the number of hip arthroscopies performed in the United States over the past two decades. Though statistics vary, the total amount of procedures done in the United States has increased by 250 percent since 2011.

“By providing post-less distraction of the hip joint, we are able to essentially eliminate the risk of pudendal nerve palsy entirely and this leads to a decreased risk of post-operative pain, decreased risk of urinary retention and any of those other comorbidities that are associated with the post,” Dr. Salata says.

To employ this new approach, Dr. Salata uses a traction pad on the operating table that maintains the patient in a position in which the feet are higher than the head.

“The pad allows for more friction of the torso and the trunk,” Dr. Salata says. “We’re then able to use their body weight as a counter-traction in order to open the joint up, eliminating the need for the post.”

Dr. Salata says he expects more orthopedic surgery centers will likely adopt the post-less hip arthroscopy technique. In the meantime, he says he’s pleased with the advantages the innovation can provide for current patients undergoing surgery at UH.

“This technique provides an improved safety profile for our patients,” he says. “It’s been incredibly successful. Our patients post-operatively have had less discomfort and it will likely improve their recovery as well.”

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