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Preventing Hip Surgery

If you have chronic hip or groin pain, you're probably looking for up-to-the minute information about how best to manage your hip condition. Lynda Huey and I are the authors of Heal Your Hips, and we have helped thousands of patients reduce pain, increase mobility, and restore function in their hips. Joining together, we have provided hip patients with alternatives to hip surgery. The more we combine our innovations the more we believe we can either prevent hip surgery altogether or at the very least buy a patient time -- perhaps a decade or more before they would require surgery. We want to buy time if we can, because the future may hold more elegant solutions to hip problems. We may not even be doing hip implant surgery ten years from now.

If your doctor has said that you need hip surgery,

Click the Stop sign if you have a torn labrum!

Many patients come to me because their former doctors have flatly told them, "I'm the doctor, you're the patient." My answer is that for me there's nothing better than patients who participate in getting themselves well. I'm delighted when they bring along popular articles on health and fitness to discuss during office visits or when they choose books to take home from my library. More power to them! And when we talk about their hips I try to avoid jargon. I want to demystify their loss of mobility, their decreased strength and loss of function. I use examples, anecdotes, Xrays, quick drawings, and photographs as I encourage their understanding of the anatomy and physiology of a hip, that elegant piece of biological machinery.

"I love to operate," I say after listening to patients describe their pain. "But I'd rather we exhaust all conservative care to get you back to health."

Back to golf, tennis, running, skiing, pick-up basketball, beach volleyball, bicycling - so many of my patients have their return to sports as a goal. And back to construction work, driving a bus, managing a restaurant, repairing computers - these recent patients of mine have sought to regain strength and mobility for their jobs. Most of my diagnoses lead to treatment in a pool where those with arthritis, congenital hip problems, rheumatoid arthritis, and even more complicated hip problems become instant athletes and unhobbled workers as they walk, run, push, pull, bend, squat, lunge, jump, and lift themselves easily. Indeed they can practice all their moves in the glove of water that protects them from pain. Many people call us from around the country, and in fact some even fly in for pool sessions with Lynda and/or consultations or surgery with me.

If you could reduce your hip pain and return to normal activities of daily life, would you care that your Xray still looks as though you have a problem? That's the same question I've asked my patients over the years, and the answer is always NO! By entering the water and insisting on gentle movement from your painful hip, you can begin to regain strength, flexibility, and mobility while you gradually reduce your pain. I always insist that my hip patients attempt a legitimate three-month effort with Lynda Huey in the pool and on land to prevent hip surgery before considering the next step: hip arthroscopy.

My patented new microsurgical instruments the size of a pencil allow me to see around the corners inside the hip joint, view the inflammation, smooth down damaged cartilage, and replace corrosive joint fluid without the high cost in tissue damage that hip surgeries normally require. Then a window of opportunity can be presented to you: before the joint becomes inflamed again, you can exercise in water and on land to regain strength and function that can save you from needing major hip implant surgery.

In 1989, I performed my first hip arthroscopy, a pioneer to say the least. Other surgeons had taken the arthroscope into the knee and shoulder, but few considered using it in the hip. So it was a lonely world for a while. I could imagine a bright future for hip arthroscopy and I saw the importance of addressing the early damage as it occurred in this complicated joint. In these past twenty years, I've performed hundreds of hip arthroscopies, and now I'm gratified that many other surgeons around the country and around the world have followed suit. I have been teaching surgeons since 1989 when they come to visit me in the operating room. Today the number of courses to teach young surgeons to do this procedure is skyrocketing and every course is overbooked. It has been a joy for me to watch this field of hip arthroscopy blossom into the fastest-growing segment of orthopedic surgery.

There are really only two reasons you should consider having hip surgery:

1. The pain has become unbearable - it keeps you awake at night and prevents you from doing the things that make your life enjoyable, or

2. The lack of function at your hip joint has begun to affect other nearby joints, most likely your knee or lower back. If the hip can't move correctly, your body compensates and makes the knee or back do some of the work that the hip can no longer do. You don't want to cause more problems. If a hip surgery now can save your knees or back, you need to do it rather than find out years down the road that you now need hip, knee, and back surgery.

-Dr. Robert Klapper, M.D.

It's possible that in five or ten years we might not be doing hip implant surgery. There may be a stem cell procedure that's appropriate. Even further into the future, gene therapy may eliminate many hip conditions. What we are doing today is diagnosing early hip problems, which allows us to correct with arthroscopy these early changes in the joint to stop or slow down the deterioration. The day will come, maybe within the next ten years, when surgeons will be able to isolate the gene for osteoarthritis. The child of parents who had OA could have that specific gene clipped or changed before he or she reaches the age of thirty or forty when the breakdown of the articular cartilage would begin to manifest. Then we will truly have a cure for arthritis. For now, the best we can do is diagnose hip problems as early as possible so we can correct the early changes in the joint with arthroscopy to stop or slow down the deterioration.

-Dr. Robert Klapper, M.D.