“Hip, Hip Hooray!”
Keith Kenter, MD
Keith Kenter, MD, Associate Professor and Program Director of the Residency at the University of
Cincinnati in the Department of Orthopedics and Sports Medicine, talks about a new hip
treatment.
What was wrong with Emily? What was causing her pain?
Dr. Kenter: Emily was presented with a long history of bilateral hip pain and she described this
down into the groin region, some mechanical symptoms with popping and catching. After a
detailed history and physical examination as well as review of some of her imaging studies, we
made a diagnosis of a labral tear with an impingement component.
What is a labral tear?
Dr. Kenter: The labrum is a fibrous tissue that kind of wraps around the socket. Her impingement
or a spur that developed on her thigh bone or the neck of the ball was rubbing up against that and
resulted in the tear.
Why did it hurt so much?
Dr. Kenter: That is a good question. We clearly see these types of tears and spurs
radiographically and we know that there are a group of patients that are asymptomatic. We will
have to ask Emily, but I think in her case this was kind of a chronic repetitive type of process that
just eventually wore and what brought her into our office.
How did you treat this problem?
Dr. Kenter: Emily had seen several different physicians and had done a variety of different
techniques. I think a lot of times we can try physical therapy; certainly if we can keep somebody
out of the operating room that would be great. We would try modalities through physical therapy.
We may try steroid injections to try to help improve the inflammatory process and I think if that
fails then eventually we do have to go to the operating room. In Emily’s case, what we decided to
do was to proceed with an arthroscopic type of approach as opposed to an open type of
approach. An open approach is where you would make an incision, dissect down through the
muscles into the joint and address the problem.
Does she have hip dysplasia?
Dr. Kenter: She might have had a component of hip dysplasia which, as a child, and never really
diagnosed. However, her symptoms were not from her dysplasia, could be a result of the
dysplasia.
What is hip dysplasia?
Dr. Kenter: There are a variety of different types of classifications of hip dysplasia. Essentially
either the ball or the socket does not form properly and that overall alignment of coverage of the
ball different growths of the ball and how that ball and socket develop with time and in her case,
she developed some spurring because of the developmental anatomy that took place.
Emily was active. Do you think her activities in sports contributed to her problem?
Dr. Kenter: YES, I am not sure her activity related to it. I would submit or almost think about her
activity brought it out. If she wasn’t as active as she was or is, she might have never known she
had a hip problem.
How did you treat her?
Dr. Kenter: We talked about options and we decided to do this arthroscopically. She had failed
non-operative treatment and with her chronicity, we decided to go to the operating room. The
arthroscopic procedure is an outpatient procedure. So Emily came in; had the procedure done
and went home that same day. We put a camera into her hip to assess the intraarticular anatomy.
And what did you find?
Dr. Kenter: In her case, we found a labral tear as expected. We ended up repairing that or
suturing that back to the socket to kind of recreate that gasket. Then she also had that spur out
on the femoral neck or the neck of the ball where we kind of débrided that or smoothed that down
so it would not be hitting against that cartilage tear.
How new is this procedure that you did?
Dr. Kenter: It has been around for some time. I think there has been case reports described in
literature since the 80s. I think it has come more to a forefront as some of our experts have
brought that to our attention; certainly some famous athletes have had surgery and that always
helps the media bring this to our attention, so I would say today, I wouldn’t say it is uncommon,
but I would say, a general orthopedic surgeon today is not doing them.
What is significant about treating the hip this way, without major surgery?
Dr. Kenter: I think it is less invasive. I think in an active patient world, and certainly as a Sports
Medicine Surgeon, we are less invasive; it is an outpatient procedure, so you can even argue the
value and the cost containment is important, but I think it allows our athletes and active
individuals or any patient to get back more quickly. I think if they are hurting less and get back to
their normal lifestyle, activities of daily living quicker, I think that is a good thing.
Who is a candidate for this?
Dr. Kenter: The ideal candidate, at least in my hands would be somebody who is active, has an
acute event; tears an anatomic structure such as the labrum.
Who is not a candidate?
Dr. Kenter: Obviously anybody that is medically unstable. Once we start seeing the degenerative
process or erosive changes of the cartilage that starts changing overall gliding mechanics and
then could be a problem with outcome.
What are the benefits of hip arthroscopic compared with other standard treatments?
Dr. Kenter: What makes this exciting for a lot patients because the days where we would have to
make a big incision, dislocate the hip to address something are going away and I think just as we
evolved around the shoulder, we have evolved around the knee, I think that is this new frontier if
you will as far as arthroscopy in joints.
What about the new frontier as far as treating the hip?
Dr. Kenter: We are now pushing the envelope. It has allowed us to understand pathophysiology,
pathoanatomy better because we can visualize it easier with the arthroscope. It has allowed us
to visualize the anatomy much better, which allows us to understand the disease process better.
The other advantage is it has allowed us to pursue new technology. We can now reconstruct
cartilage.
What is it about the arthroscopy; that you can see inside?
Dr. Kenter: It is magnified, we can see inside the hip a lot easier. Now, there are clearly
limitations with anything we do, but magnifying the tissue and addressing that with a more
magnified view allows us to do more.
What are the concerns of doctors who don’t use this procedure?
Dr. Kenter: Orthopedic surgeons need to be aware of the procedure and then if they don’t do that
because of the technical demands, transfer that or refer that to one of their colleagues.
Emily struggled with so much pain. She went to so many doctors and people would tell
her she was, it was just growing pains. Why do you think that was so hard to get to the
bottom of her problem?
Dr. Kenter: It is technically demanding; we did not have the proper equipment, so our industry
didn’t market or pursue the equipment and it is hard to examine a hip. The level of accuracy
making a diagnosis based on a history and physical exam is a little bit more challenging then say
a knee.
What advice would you have for people who can’t get an answer for their pain?
Dr. Kenter: Listen to your patient. You need to understand what they are trying to relay; a good
complete physical examination with good imaging studies.
What advice would you have for a patient who goes from place to place?
Dr. Kenter: Emily did a good job. She took an active role in her care and communicated her
concerns with her physicians and somehow found the right place to go. With availability of
internet and social media, we are a much closer community and society and I applaud Emily.
She took a very active role in trying to figure out what she could do to get her hip better.
This information is intended for additional research purposes only. It is not to be used as
a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional
interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or
accuracy of physician statements. Procedures or medicines apply to different people and
medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Becca Richter
University of Cincinnati
Department of Orthopaedic Surgery & Sports Medicine
richter@UCPHYSICIANS.com
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