UH Orthopaedic Surgeons Share Novel Combined Technique for Treatment of Femoral Acetabular Impingement and Hip Dysplasia on International Stage

Innovations in Orthopaedics | Summer 2023

Last fall, Michael Salata, MD, and Robert Wetzel, MD, gave a keynote address from dual podiums at the International Society for Hip Arthroscopy and Preservation’s 2022 annual Scientific Meeting in Glasgow, Scotland.

Michael Salata, MD

Robert Wetzel, MD

Addressing more than 500 hip surgeons participating in person and virtually from around the world, they presented their combined surgical approach to hip arthroscopy and open hip preservation to correct the concomitant pathologies of femoral acetabular impingement (FAI) and hip dysplasia.

The pair were among the first in the country to offer patients a combined two-stage procedure to treat the complex problem of hip dysplasia and femoral acetabular impingement (FAI) using a single position, surgical drape and sterile field.

Describing footage of a surgery performed at University Hospitals Cleveland Medical Center, Drs. Salata and Wetzel discussed their novel approach and collaboration over the past eight years. They also shared their unique setup and the recent addition of the Stryker Pivot Guardian Table, a state-of-the-art surgical table with a hip distraction system that accommodates multiple hip specialties and eliminates the need for patient transfers between the arthroscopic and open stages of their procedures.

“We were among the first hospitals in the world to use the Stryker table for this application,” says Dr. Salata, Director of the Joint Preservation and Cartilage Restoration Center and Division Chief of Sports Medicine at University Hospitals Center for Orthopedics, Professor at Case Western Reserve University School of Medicine and the Associate Orthopaedist Team Physician for the Cleveland Browns. “The table is helping to revolutionize these procedures and improving patient safety while decreasing operating room times.”

After his and Dr. Wetzel’s initial success, the Stryker table has been adopted by the Mayo Clinic and other healthcare systems around the country as the preferred setup for these procedures.

A Collaborative Approach for Complex Conditions

“Dr. Salata and I treat a young adult population with two distinct disease entities that often coexist,” says Dr. Wetzel, an orthopaedic trauma surgeon and Program Director of Orthopaedic Trauma Fellowship within the UH Department of Orthopaedics and Assistant Professor at School of Medicine. “Often in the past, just one of the issues was surgically addressed at a time because these two procedures require vastly different skill sets.”

During the first stage of the procedure, Dr. Salata uses arthroscopic techniques to round the femoral head, improve offset and repair damage resulting from FAI. The first orthopaedist at University Hospitals Cleveland Medical Center to perform arthroscopic hip procedures, he has since completed more than 4,000 surgeries utilizing minimally invasive techniques.

With the arthroscopy complete, Dr. Wetzel subs in to perform open surgery to deepen and reorient the hip socket. “This is a challenging patient population who often has a difficult presentation and pain or dysfunction that has been going on for years,” he says. “By collaborating on a combined procedure, we effectively eliminate a second anesthetic event, separate hospital bill and an entire rehabilitation period.”

A Growing Census

Promising data demonstrate that surgical interventions for FAI and hip dysplasia reduce the risk of developing severe arthritis and may delay or prevent the need for hip replacement. “It has been shown in our series, as well as others around the world, that these procedures decrease pain and improve function,” says Dr. Salata.

He and Dr. Wetzel have been tracking outcomes since their first combined procedure in 2016 and have published their techniques. Currently, they are in the process of publishing long-term results. Having completed hundreds of procedures, they see patients who travel from the Greater Midwest region. “We have a steady referral from West Virginia, Northwest Pennsylvania and parts of Kentucky because we provide master-level treatment of both pathologies,” says Dr. Wetzel.

Leading the Way in Orthopaedic and Sports Medicine

Starting this summer, patients can access complete orthopaedic and sports medicine care at the newly opened UH Drusinsky Family Sports Medicine Complex on the campus of UH Ahuja Medical Center. The multistory, 20,000-square-foot complex offers clinical care and treatment for all ages, an unparalleled Sports Performance Center for rehabilitation and physical therapy, injury prevention and performance assessments.

“At UH, we have the ability to take care of people and their orthopaedic needs throughout the course of their lives and provide leading-edge rehabilitation to help them achieve their goals,” says Dr. Salata.

For more information or to refer a patient with hip pain or a diagnosis of FAI or hip dysplasia, call 216-983-PLAY (7529) to consult with Dr. Salata and Dr. Wetzel.

Contributing Experts:
Robert Wetzel, MD
Orthopaedic Trauma Surgeon
Program Director, Orthopaedic Trauma Fellowship
Department of Orthopaedic Surgery
University Hospitals Cleveland Medical Center
Assistant Professor
Case Western Reserve University School of Medicine

Michael Salata, MD
Director, Joint Preservation and Cartilage Restoration Center
Division Chief, Sports Medicine
Department of Orthopaedic Surgery
University Hospitals Cleveland Medical Center
Professor
Case Western Reserve University School of Medicine
Associate Orthopaedist Team Physician, The Cleveland Browns