Texas Tech Health Check
Texas Tech Health Check
Hip Preservation Surgery: When and Why to Consider It
Hip pain can impact our quality of life significantly, but traditional hip replacement surgery may not be the only option. Matthew Kraeutler, M.D., an orthopedic surgeon with Texas Tech Physicians, talks to us about hip preservation surgery, procedures designed to delay or prevent the need for a total hip replacement. He tells us who is a good candidate, goes over some of the symptoms, explains PRP therapy and what patients can expect.
Melissa Whitfield 00:09
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, healthcare providers and researchers. Hip pain can impact our quality of life significantly, but traditional hip replacement surgery may not be the only option. Dr. Matthew Kraeutler, an orthopedic surgeon with Texas Tech physicians, talks to us about hip preservation surgery, procedures designed to delay or prevent the need for total hip replacement. He tells us who is a good candidate, goes over some of the symptoms, explains PRP therapy and what patients can expect.
Melissa Whitfield 01:09
Dr. Kraeutler, welcome to our podcast.
Matthew Kraeutler, M.D. 01:11
Thank you so much for having me today.
Melissa Whitfield 01:13
Can you tell us a little bit about yourself, your expertise and what you do here at the Health Sciences Center and at Texas Tech physicians?
Matthew Kraeutler, M.D. 01:20
Sure. Well, my name is Matt Kraeutler. I've been here at Texas Tech University Health Sciences Center for about three months now in the department of orthopedic surgery and rehabilitation and my expertise is in orthopedic sports medicine as well as hip preservation. I did two fellowships, the first in sports medicine at Houston Methodist and the second in hip preservation at the University of Colorado.
Melissa Whitfield 01:44
Well, welcome to our podcast.
Matthew Kraeutler, M.D. 01:46
Thank you so much.
Melissa Whitfield 01:47
So can you tell us what is hip preservation surgery and who, who is it for? Who are good candidates for it?
Matthew Kraeutler, M.D. 01:55
Sure. Well, hip preservation surgery is the collection of surgeries that I do in order to maintain a patient's native hip joint, rather than to replace it. These patients are typically between the ages of somewhere around 16 to 55 and it's really for patients who have specific pathologies that we'll discuss, and who have no or minimal hip arthritis. If a patient has moderate or severe hip osteoarthritis, they're really no longer a candidate for hip preservation surgery, and at that point become candidates for hip replacement surgery.
Melissa Whitfield 02:36
What are some of the most common conditions or symptoms that lead to hip preservation surgery?
Matthew Kraeutler, M.D. 02:42
Sure. So, there are really three key pathologies that I focus on and that I would treat surgically if present in a patient who I see. Most common of these is something known as Femoroacetabular Impingement, or FAI. This is the most common cause of hip pain in young adults. And when surgery is needed in these patients, we can treat this minimally invasively with something called hip arthroscopy. The second most common pathology that I see is hip dysplasia. And typically we think of hip dysplasia as being seen in either babies or in dogs. But when I see it in adults, these are the patients who had mild dysplasia as a newborn, and so it was missed or it never needed to be treated during the first few years of life. And these patients were able to live for the first 20, 30, sometimes even 40 years of their life without hip pain. But then at some point the hip dysplasia becomes a problem and starts causing hip pain. And then the last condition that I see and we treat surgically is something known as Femoral Torsion abnormalities. This is certainly the least common condition that I need to treat surgically and something that is most often overlooked by other surgeons. But this is something where, you know, you might see patients who walk with their toes pointed outward or inward and when it's severe enough then I can treat it surgically and get those patients walking more normally.
Melissa Whitfield 04:27
About how long is recovery?
Matthew Kraeutler, M.D. 04:31
Sure. Well, recovery really depends on what specific procedure I need to do for these patients. I mentioned that hip arthroscopy for FAI is the most common procedure that I do for these hip preservation candidates, and fortunately, that's the procedure with the shortest recovery time. These patients are back on their feet. They're using crutches, but in most cases, they can weight bear as tolerated right after surgery. These patients are beginning physical therapy within just a few days of surgery and they're back to jogging around eight weeks after surgery. And when are they back to sports such as running or playing basketball, playing soccer? Well, they're getting back into those activities somewhere around 10 to 12 weeks after surgery. And they're participating at full capacity, probably around 14 to 16 weeks after surgery. Now, if someone needs surgery for hip dysplasia, a surgery known as a Periacetabular Osteotomy or a PAO. That's a much longer recovery. This is a much more invasive surgery. These patients are not even starting formal physical therapy for about six weeks after surgery and they're not really getting back into sports activities until 5, 6 or even 7 months after surgery, and those patients are not participating at full capacity until about a year after surgery. So it really depends on what specific surgery we're talking about when we talk about how long is the recovery period.
Melissa Whitfield 06:18
How is preservation surgery different from a hip replacement, and are there other procedures available?
Matthew Kraeutler, M.D. 06:26
Sure. Well, the main benefit of hip preservation surgery over a hip replacement is that a patient gets to maintain their native hip joint. And so what that means is that once the patient has gone through their rehab period and they're fully healed, they have no further restrictions. They can participate in whatever activities they would like. They can get back to running marathons. They can ski black diamonds. Get back into CrossFit. Whatever they want to do, they have no further restrictions. Whereas, if a patient undergoes a hip replacement they really should not be participating in those activities that I just mentioned, because if a patient with a hip replacement is running marathons or skiing black diamonds, they're putting a lot of impact on their prosthesis and that means they're going to wear out their prosthesis much more quickly. And at some point, will likely need a revision hip replacement and those procedures are much more difficult than a primary hip replacement. And so that's the key benefit of hip preservation surgery. Now, are there other procedures available? Well, there is a type of hip replacement procedure known as hip resurfacing. This is not something that I do but this is sort of in the middle of hip preservation surgery and a total hip replacement. And a hip resurfacing procedure is specifically for those 40 or 50 year old patients who want to continue high activity but they need a hip replacement of some sort because they have hip arthritis that is too severe to make them still a viable hip preservation candidate.
Melissa Whitfield 08:29
What is PRP therapy? And how does that work?
Matthew Kraeutler, M.D. 08:33
Sure. Well, PRP stands for Platelet Rich Plasma, and this is something I do frequently in my clinic. These are injections that are safe and have proven long term efficacy. When I say long term, I mean, studies have shown that patients can have symptomatic improvement for up to a year after these injections. And if they do have symptomatic improvement for a year, that's great, then I would recommend they come back next year and we do it again. So what is PRP? PRP is when we draw a patient's own blood in the clinic. So one of my nurses will draw a patient's blood when they come into clinic. We centrifuge it right there in the clinic, and we do that to isolate a patient's platelet rich therapy, or platelet rich blood, which is rich in anti-inflammatory and growth factors. And then inject those anti-inflammatory rich blood back into a patient's hip joint or knee joint. It's safe because it's simply a patient's own blood products that are going back into their joint. And how does it work? Well, all of those very strong anti-inflammatory properties that are present within a patient's blood, we're putting them into their hip or knee joint. And it's a very strong anti-inflammatory, so it gives them good pain relief. Now I should say, compared to, say, a corticosteroid injection, these injections can take, typically, about four to six weeks to really kick in and have a patient notice that it's working. But once it starts working, as I mentioned, it can last for about a year. And so when a patient comes in with, say, mild or moderate osteoarthritis of the hip or knees, this is my first time primary recommendation.They might not have anything that can be surgically treated but they're not yet a candidate for a hip or knee replacement because their arthritis is not quite that bad yet. And so I think PRP therapy is the perfect solution for these in between patients.
Melissa Whitfield 11:00
So you would say it's a good way to prevent or delay surgery.
Matthew Kraeutler, M.D. 11:03
It's certainly a good way to delay surgery. I should mention that PRP therapy has not shown any benefit in delaying the progression of arthritis or eliminating the progression of arthritis, but it certainly helps with symptoms. And so it can delay surgery simply by improving a patient's symptoms, sometimes up to a few years if these patients undergo these PRP injections every year for a few years. But I should not say that it can prevent surgery. At some point, these patients will ultimately need surgery, but it can make them feel good in the meantime. Now, how many sessions are needed? Well, there's some evidence that a series of three PRP injections, typically about three weeks in a row, is better than just a single injection. So that is my recommendation when I see these patients. If you can afford these injections, because they are out of pocket. Insurance companies unfortunately don't cover these at this time, then I would recommend a series of three injections, because again, there's some evidence that that's better than just a single injection.
Matthew Kraeutler, M.D. 11:48
Now, you did mention cost and this might prevent somebody from getting their symptoms addressed. What happens if somebody ignores their symptoms?
Matthew Kraeutler, M.D. 12:31
Well, if a patient ignores their symptoms their pathology will continue to progress, and that means that their hip or knee will continue to deteriorate over time. Now, if I see a patient early on before they've started to develop arthritis in their hip, that is why we can do hip preservation surgeries to try to lessen the risk that they will eventually need a hip replacement. But if a patient ignores their symptoms, their hip will eventually break down, and their arthritis will continue to progress, and at some point, they will no longer be a hip preservation candidate, and at that point, the only surgical treatment that would be appropriate for that patient is some sort of a hip replacement.
Melissa Whitfield 13:22
Is there something that we can do before we start having symptoms or is there a way to prevent or delay and what kind of symptoms should we be looking for?
Matthew Kraeutler, M.D. 13:31
So often I will see patients in the clinic who present with unilateral symptoms, but I always get bilateral X rays when a patient comes into the clinic, and usually a patient will have symmetric looking hips on their X rays even if they come in and only one of their hips is hurting. But I tell them, it's likely that at some point your other hip will start hurting because it has the same pathology as your other hip. It just hasn't started causing pain yet. Now, I would never recommend surgery or even injection treatment for a hip that is not yet having symptoms, but what I will tell a patient is, if your other hip starts hurting, come back and see me so we can address this quickly, because there are multiple studies showing that patients who present quickly and have hip preservation surgery after a short duration of symptoms. Those patients do better than patients who eventually have surgery, but after a longer duration of symptoms, say, two years or longer. Now, what are the most common symptoms that patients present with, with hip pain? Well, most common is anterior groin pain. Patients will either point to one spot in their anterior groin or they'll sort of draw a line along their anterior groin crease and say, you know, my, my pain is deep in here. I can't touch it, but it's deep in here. That's most common. Second most common is in a lateral hip. The point deep in their lateral hip They might give what we call the C sign, and sort of wrap their hand around their hip and say it's deep in here. And then the least common, but still a source of pain that patients will tell me about is posteriorly. So they'll point deep in their buttock, and that's where the hip joint is, and they'll say that my pain is deep in here. Again, I can't touch it, but it's deep in here. That's least common, but still a valid source of intra-articular hip pain.
Melissa Whitfield 15:55
Is there anything else that you would like to add?
Matthew Kraeutler, M.D. 15:57
Sure. Well, I just like to say, if you're a potential patient, and you think you're having any of the hip symptoms that I had mentioned, or you're a physician, and you think you might have a patient who is having these sorts of symptoms. And again, they're within the preservation age range of somewhere between 16 and 55 and they haven't developed severe arthritis yet. You know, come in for an evaluation. It doesn't mean that I'm gonna recommend surgery right away, and you always have that option when you come see me, but come in and we can have a discussion and figure out what's the right treatment for you.
Melissa Whitfield 16:38
Well, thank you again so much, for coming on our podcast and definitely giving us some great information on hip preservation surgery. Because I think as we get at so many more of us get older, we're gonna start complaining about aches and pains, and now we know that there's an answer for it. So thank you.
Matthew Kraeutler, M.D. 16:56
Thank you so much for having me. I really appreciated being on here today and hopefully it's helpful for the patients out here in West Texas and any physicians listening who might be seeing any potential patients.
Melissa Whitfield 17:10
And we hope to have you come back and talk to us about knees at some point too.
Matthew Kraeutler, M.D. 17:13
That sounds great. Thank you so much.
Melissa Whitfield 17:15
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.
Melissa Whitfield 17:15
Thank you.