Fixing ailing hips with less cutting

March 13, 2009 7:26:30 AM PDT
It's the type of surgery Phillies star Chase Utley had in November, and Yankees slugger Alex Rodriguez on Monday. Golfer Greg Norman credits it with getting him back on the pro tour.

Hip arthroscopy is getting athletes back on the field faster.

But insurance problems are making it hard for some ordinary Janes & Joes to get.

Nick Locilento of Winslow, N.J., was a gung-ho football player since he was a little boy.

"Nothin' takes me off the field. I just try to do whatever it takes," he says.

Last fall at practice, he pivoted making a play, and suddenly went down with an injured right hip.

He played out the season, not telling anyone about the pain he felt.

Nick told Action News what it felt like, "Irritating, like somebody's just constantly poking me, or link pinching me."

Sheryl Neely is no athlete.

But this emergency dispatcher and mother of 2 had similar hip pain.

"Getting out of a chair, going up & down steps, there would always be pain in the groin area," she told us.

Both had small tears in the labrum-- it's the cartilage that lines the socket portion of the hip.

For them, Dr. John Salvo of Cooper University Hospital's Bone & Joint Institute recommended arthroscopic surgery.

The procedure - using small incisions, and narrow viewing and cutting tools - has been used for knees for decades.

But Dr. Salvo says it's been a challenge for hips, because the joint is deep, tight, and surrounded by muscles.

"There is such a muscle envelope around the hip, it is so thick, you can't really put your finger on it, and point to where the pain is."

Surgical tools used for the knee just don't work, "You;re either not going to see what you want to see, oer you could do some damage."

But new tools are now making it easier.

Dr. Salvo says, "They allow us to safely enter the joint, and do the work we need to."

In the operating room, he showed Action News cameras how one of them functions, "It works all the way 90 degrees in one way, and then you pull the trigger, and go around 30 degrees the other way."

With the scopes, Dr. Salvo can remove floating or loose tissue that gets caught in the joint during movement.

Dr. Salvo says hip arthroscopy is also good for ligament tears deep inside the hip, minor arthritis, or what's called "hip impingement," in which 2 different parts of the bones in the hip rub against each other. Sometimes, people with these problems report "clicking" sounds when they move.

"The most common sports with these kinds of injuries - ice hockey, soccer, gymnastics, and cheerleading. And sometimes with dance, too. The positions they get into, and the torque they put across the hip, it can cause a traumatic tear across the labrum," says Dr. Salvo.

He believes treating these problems early can lengthen the time before a hip replacement is needed.

"It gives them back their quality of life," he says.

Two weeks after surgery, Nick is weaning himself off crutches.

Sheryl was done with hers 4 days after the operation. At the 2-week point, she is almost ready to go back to work.

She told us, "I never had any pain. Just sore and tense, a little tight in that area, but never had any pain."

There's a hitch to the arthroscopic approach. Some doctors have no problem getting insurance to pay for it, but others do. Several major insurers say its still considered experimental. One doctor told us he has 35 patients waiting for the procedure. Their company would rather they go for the more drastic total hip replacement operation.

For more information on the procedure, and to see a Q&A session with Dr. Salvo, go to Cooper Bone & Joint Institute.

In addition to the Cooper Bone & Joint Institute, Pennsylvania Hospital, Jefferson University Hospital, and Virtua Health System are among the other medical centers in the Delaware Valley performing hip arthroscopy.

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