At Home with Chris Jessen 2018 - 171
'IT'S REALLY IMPORTANT THAT WE EXPLAIN
CLEARLY TO OUR PATIENTS THE CAUSE
OF THEIR HIP PAIN, THE OPTIONS, AND
THE REHABILITATION, SO THEY CAN PLAN
TREATMENT TO FIT IN WITH THEIR BUSY LIVES.'
cause these problems in young adults.
Femoroacetabular impingement (due
to a hip socket that is too deep, or an
abnormal lump of bone on the side of
the ball part of the joint - called a cam
deformity, see diagram, below), plus
acetabular dysplasia (which is where
the socket is too shallow), are the two
main issues. Surgeon Tom explains:
'Identifying young patients with hip-joint
pathology is relatively straightforward
- pain in the groin is a classic symtom,
although it may be referred from
elsewhere, and initially tends to be
intermittent and worse with ﬂexion
activities (driving, sitting, sports), before
becoming constant and independent of
activity. Clicking or a feeling of
instability usually signiﬁes a labral tear.
A simple examination test will conﬁrm.'
Diagram of the hip joint
The next step...
It's common for an outpatient X-ray
to be reported as 'normal', but the
subtle and important abnormalities
of joint shape may not be highlighted.
One of the key aspects of specialist
assessment is to organise the correct
imaging - including MRI scans - to
highlight subtle hip-shape abnormalities
and identify what damage has actually
occurred in the joint.
Some patients will respond well
to conservative treatment (antiinﬂammatories, activity modiﬁcation,
physiotherapy), but those whose
symptoms do not respond or return
after conservative treatment, may
be best treated with surgery. Hip
arthroscopy enables both treatment of
the damaged labrum and cartilage, and
perhaps crucially, can frequently correct
the bony-shape abnormalities of the
joint, thereby potentially preventing
further injury and the progression of
osteoarthritis. The operation is
performed as a day-case or single
overnight stay in hospital.
Occasionally hip arthroscopy may
need to be augmented with an
osteotomy (where the bone is cut and
reset) of the femur or acetabulum to
adequately address the joint
mechanics. Hip arthroscopy is usually
not helpful in patients with a very
shallow (dysplastic) acetabulum, or
advanced osteoarthritis. Deciding on
the best intervention strategy is not
always straightforward and requires
detailed discussion of the risks,
implications and rehabilitation of both
operative and non-operative options,
between the patient and surgeon.
'COULD I HAVE A
PROBLEM with my hip?'
These are the signs to look out for:
Pain in the groin, side or back
of the hip
Aching on driving or sitting
Pain made worse by bending
or twisting the hip
Clicking, catching, locking in
A feeling that the hip is giving way
or coming out of joint.
MEET THE EXPERT
Mr Tom Pollard
is a consultant
hip and knee
surgery, with a
subspecialist interest in young adult hip
surgery using arthroscopic (keyhole)
techniques. His NHS practice is at the
Royal Berkshire Hospital, Reading,
where he is clinical director of the
orthopaedic department. His private
practice is based at Circle Reading,
Spire Dunedin, and the Berkshire
Independent Hospitals, and he also
consults in Windsor and Ascot.
Mr Pollard sees approximately 250 new
'young adult hip' patients per year and
performs around 200 hip arthroscopies
annually. He has now performed over
1000 hip arthroscopies since becoming
a consultant in 2012, making him one of
the highest-volume hip arthroscopists
in the country.
Tom is at the forefront of surgical
development and research related
to young adult hip problems. He
trains surgeons across the UK in hip
arthroscopy and is regularly invited
to give lectures both nationally, and
internationally. Tom considers hip
preservation surgery to be one of the
most exciting and quickest developing
ﬁelds of modern orthopaedic surgery.
FOR MORE INFORMATION
Call 0118 9226915