Treatment of labral tears, femoroacetabular impingement (FAI),
hip dysplasia and hip arthritis in the young patient
Surgical expertise in hip arthroscopy, femoral pelvic osteotomies
and direct anterior total hip replacement
Complete surgical care of the active patient with hip pain
Hip preservation is a unique and emerging field in medicine and our specialists are able to provide young patients with leading-edge care. At The Ohio State University Wexner Medical Center, hip preservation is highlighted by a multidisciplinary program approach that includes physicians, clinicians and researchers from orthopaedics, physical therapy, athletic training, clinical sports psychology, radiology, family practice and sports medicine.
Thomas Ellis, MD, vice-chair of the Department of Orthopaedics and chief of the Division of Hip Preservation, specializes in the treatment of hip disorders and pain in the young, active, adult patient (< 50 years old). He performs all surgeries for the hip, including joint-preserving surgeries (hip arthroscopy and hip osteotomy) and joint replacement surgeries (including direct anterior total hip replacement).
He is an expert in the treatment of hip labral tears, FAI, snapping hip, hip dysplasia, hip arthritis and avascular necrosis. His extensive experience in hip arthroscopy for labral tears or FAI, Ganz periacetabular osteotomy for hip dysplasia, femoral osteotomies and direct anterior hip replacement has made him one of a few surgeons in the nation able to offer the full completment of treatment options to this patient population.
Many different hip procedures can be performed arthroscopically including the following most common procedures:
Femoroacetabular Impingement (FAI) is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head (hip ball) and the rim of the acetabulum (hip socket), which leads to damage to the articular cartilage (lining or gristle) in the acetabulum, or to the labrum of the hip, or both.The labrum is a ring of cartilage that surrounds the acetabulum and looks very much like the meniscus of a knee joint, although its function is different.
Damage to the labrum and/or articular cartilage will likely cause pain. An abnormality in the shape of the femoral head or acetabulum, or both, may cause FAI. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact, such as kicking sports. FAI generally presents in three forms: cam impingement, pincer impingement and mixed impingement (involving both cam and pincer type). FAI can affect all age groups from the early teens and throughout adult life and is being increasingly recognized as a factor that may predispose patients to osteoarthritis of the hip. It is felt by many that without early intervention surgery, there is a high likelihood of developing osteoarthritis with the subsequent requirement for either a hip replacement or other major hip operation. Hip arthroscopy can be used to reshape the femoral head and socket to prevent impingement, and aims to protect the hip from developing osteoarthritis, in addition to relieving current symptoms.
Benefits of Hip Arthroscopy
In acetabular dysplasia, the hip socket is poorly developed, resulting in a socket that is shallow and shaped like a saucer, rather than a cup. The top part of the socket is obliquely inclined, and it incompletely covers the ball.This results in abnormally high stress on the outer edge of the socket (also called acetabulum) and leads to early damage to the acetabular articular cartilage or the adjacent acetabular labrum. Once this damage occurs, individuals often begin experiencing hip pain.
Treatment of hip dysplasia depends on a variety of factors:
In patients with mild dysplasia and symptoms, physical therapy for core strengthening or a short course of anti-inflammatory medications may be indicated. If patients are more symptomatic or have mild symptoms but a more severe degree of dyplasia, a surgery called a periacetabular osteotomy may be indicated. Also referred to as a Ganz osteotomy or a PAO, this surgery involves cutting the pelvic bone and then rotating the socket to a more normal position. The cut socket is then reattached to the pelvis using screws.
In the appropriate patient, treatment of hip dysplasia with a periacetabular osteotomy may improve pain and delay or possibly prevent the onset of hip arthritis. Patients with hip dysplasia who have painful hip arthritis are often best served with hip replacement surgery. The periacetabular osteotomy surgery is usually performed on patients under age 40, but occasionally, individuals over 40 are candidates for this surgery. In most cases, individuals over 40 with painful hip dysplasia already have moderate arthritis, and are usually best treated with hip replacement surgery.
Benefits of Pelvis Osteotomy
Total hip replacement is an effective treatment for hip arthritis that is nonresponsive to conservative care. During traditional hip replacement surgery, muscles are cut during the surgical procedure to enable the surgeon to gain access to the hip joint. With direct anterior total hip replacement, no muscles are cut.
The surgeon is able to access the joint by going between individual muscle groups.This leads to a shorter hospital stay and less recovery time. This technique is rapidly gaining popularity in the U.S. as its benefits are realized. Dr. Ellis is one of a handful of surgeons in the region who offers this treatment option.
Benefits of Direct AnteriorTotal Hip Replacement
Dr. Ellis focuses his research on hip preservation and its outcome. He recently implemented a clinical outcomes database that captures presurgical, surgical and postsurgical datapoints. “By following our patients for up to 20 years, we will be able to identify which treatment options work best for patients — not just for an immediate fix, but for long-term success,” says Dr. Ellis.
Additionally, he is collaborating with researchers within physical therapy to evaluate the effectiveness of nonoperative treatment of femoroacetabular impingement (FAI) and on preoperative predictors of outcomes following surgical treatment of FAI.
Dr. Ellis is also collaborating with researchers in the Department of Radiology at the Wright Center of Innovation to develop advanced imaging techniques for the hip, including cartilage imaging sequences. By collaborating with the clinical and research arm of a wide range of departments,The Ohio State UniversityWexner Medical Center is able to focus on continuing to provide patients with the best and most personalized treatment options available for hip pain and hip disorders.
Please call (614) 293-3541 to schedule a referral. We partner with referring physicians to provide specialty orthopaedics care for patients. Our policy is to accept all patients referred to our Department. If we determine that a referred patient would be better served by another specialty, we will arrange that visit for the patient.