January 28, 2015
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Joint salvage surgery beneficial, defers arthroplasty in select patients

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KOLOA, Hawaii — Femoroacetabular impingement surgery and developmental hip dysplasia joint salvage surgery provide improvement in pain and function, however, it is unknown whether these procedures will change natural history, according to a presenter here.

“Does joint salvage surgery work, or more importantly, does [femoroacetabular impingement] FAI surgery work? It depends on what your definition of ‘work’ is? It works if you consider pain relief for the majority [and] improvement of various validated outcomes scores for the majority [of patients], FAI surgery seems to work for both open and arthroscopy. It is unknown if it will defer arthroplasty. I do not think we will be able to say that for many years,” Robert T. Trousdale, MD, said.

Robert T. Trousdale

He said joint salvage surgery is beneficial and can defer arthroplasty for a subgroup of patients. These are young patients with acetabular structural changes, such as developmental hip dysplasia and retrotorsion with preserved articular cartilage. The goal of treatment should be pain relief and restoration of the anatomy as close to normal as possible if viable articular cartilage remains, he said. Most minor structural problems, if nonoperative options have failed, can be handled arthroscopically.

“Open surgery is gone for this patient population,” Trousdale said.

However, major structural problems still need to be done with an open procedure for a subset of patients with a major pathology — those with a grade 3 slip or patients with posterior compartment hip diseases where arthroscopists have a tough time reaching, he said.

“In young patients, and I emphasize young patients, who have symptomatic structural problems, either hip dysplasia or marked impingement problems, if nonoperative things have failed and the pain is bad enough, then the only way to restore the anatomy close to normal is going to be either arthroscopy or an open procedure,” Trousdale said. — by Kristine Houck, MA, ELS

Reference:

Trousdale RT. Does joint preservation defer arthroplasty? Presented at: Orthopedics Today Hawaii 2015; Jan. 18-22, 2015; Koloa, Hawaii.

Disclosure: Trousdale has no relevant financial disclosures.