– Hi I’m Susan Taylor with Scripps Health in San Diego, California. Please subscribe to our
Scripps Health YouTube channel. We’ve got cool videos featuring
the very latest technology, our stellar doctors, and
inspiring patient stories. Okay you play soccer, football,
you dance, you’re a runner, a weekend warrior, you’re young, and you’ve got a lot of pain in your hip and it’s slowing you down,
something’s not right. But is the answer a hip replacement? Not necessarily. There’s something much less
invasive called hip arthroscopy. Here to talk about it
is Dr. Ryan Rebolledo. He’s an orthopedic
surgeon at Scripps Clinic in LaHoya, California,
specializing in sports-related injuries of the hip,
knee, shoulder, and elbow, and he’s got a lot of experience
training elite athletes. In fact at one time, he was
the assistant team doctor for the San Francisco 49ers Football Team. Dr. Rebolledo, thanks for joining us. – Thanks for havin’ me. – So you have experience
in minimally-invasive, arthroscopic surgery, so
let’s start with the basics. What is that for the hip? – So arthroscopy is a
minimally-invasive approach. So this is where we use poke holes around the hip to access the joint. Rather than a large incision,
we’re able to access the joint through small poke holes. We use a camera and
instruments to address the hip. – So how does it work? – So, with this model,
you can see in terms of what we typically do. For hip impingement,
which is something that we commonly use, excuse me, commonly
treat, is where we address some of the abnormal
shape to the hip joint. With an abnormal shape to the hip joint, you can have what’s
called cam impingement, where’s there’s extra
bone along the femur, and this can impact up against the rim of the acetabulum or socket. This can injure the soft
tissue structures between it. In addition, you can
also have over-coverage, where the socket is overlying
the ball part of the hip, and that can also cause
soft tissue disruption. There are others where you can also have sub-spine impingement, all
of these can be addressed with our arthroscopic approach. – And so, what is it, I
mean, how does it work? You’re not actually cutting the hip. – So, we’re not cutting the hip. What we’re first doing
is actually addressing the soft tissue structures within. So we access the hip
through the poke holes. Using the camera and the
instruments, we’re able to stitch back the labrum,
back to where it belongs. – [Susan] And the labrum is? – The labrum is a soft tissue structure that surrounds the hip,
that’s important for stability and function of the hip. And so it’s important for us
to be able to repair that, that we’re able to access that joint. This is different from the way
it was done many years ago, where you actually had
to dislocate the hip, a big open procedure with a long recovery. So, this is one that we’re
able to get back people a lot faster in terms
of what they wanna do. In terms of fixing the
labrum, we also wanna address why it was actually
injured in the first place and a lot of times it has
to do with hip impingement, so this is where we actually
take a lot of times a bur, and reshape the bone to hopefully prevent this from happening again. – What’s a bur? – A bur is a device
that can cut away bone, so it oscillates or it
spins, and from that we can actually trim the bone down. – [Susan] So you’re shaving the bone? – [Dr. Rebolledo] We’re shaving the bone. – Very cool, and who’s a candidate
for this type of surgery? – So, the best candidates
are those that are active, those that have really
failed conservative measures, and are still bothered by it. At that point, for those who actually have objective findings here
based on their examination as well as their MRI, those with hip
impingement-related findings are probably the best-suited for that. So young, active patients typically. – And why would you not
recommend hip replacement surgery for somebody who is young and active? – The reason why we don’t
necessarily recommend hip replacement surgery, if you don’t have advanced arthritis, then it probably is not
the most appropriate. This is the best procedure
in terms of getting you back to more of a functional level. And for someone who
does not have arthritis, a hip replacement would
not make much sense for that patient. And so this is one, especially
if we’re able to repair and treat the issues and hand, we feel that we’re able
to make a big difference in terms of that natural
history of the hip, to hopefully prevent, necessarily, a hip replacement in the future too. – And why don’t you wanna
do hip replacement surgery on a young person? – Well, for a number of reasons. Number one, it can be limiting in terms of what activities you can go back to. It’s almost like tread on a tire, if you are active on a hip
replacement, you can wear it out. In addition, they don’t last forever, and so if you’re very young, you could have numerous
surgeries down the road and the outcomes necessarily
for hip replacement, numerous times over, are not quite as good as they are the first time. So this is one where we’re
able to use the same parts and obviously save the
patient’s tissue a lot of times, which is why we do hip arthroscopy. – How long do new hips last, if you have to have a
total hip replacement? – The data has shown that it
does last probably 20-25 years, and that’s using the devices that we had, or the instruments that
we had many years ago. – So if you’re a young person, in your, you know 30’s, 40’s,
and you have an injury, you don’t wanna have a
new hip, because then in your 50, 60, 70’s, you have
to have another hip again. – Exactly, and also too, you
don’t necessarily go back to the activities that you want to. So running on a hip replacement, not necessarily recommended. Playing soccer, basketball,
all the activities that you potentially wanna get back to, that’s not something
that a hip replacement really can allow you to do. And so, that’s why hip arthroscopy, especially again for those
who don’t have arthritis, and that are young, active, and otherwise have good healthy tissue, we feel we’re able to
get those people back to what they wanna do. – And this is outpatient surgery? You actually go home the same day? – You ‘re home the same day, so people otherwise pretty comfortable. So usually, we give them
anesthetic at the time of surgery, and the procedure itself
typically takes about an hour and a half to two hours, they go home soon thereafter. Most people really are not on pain meds for any extensive period of time, and otherwise, on that hip, right away. – And do you literally
walk right out of surgery, I mean, you’re on crutches walking out? – (laughs) You can yeah, yes, you’re able to put
weight on it right away. I let you get on the
stationary bike day of, and we send you home
with a motion machine. So the idea is to get you
movin’ almost immediately. – And then when can you
go back to resuming, you know, your level of activity? Let’s say you’re a runner
or you play soccer, how fast can you get back
to doing those things? – So that varies for some. The big issue is really kinda getting the muscle function back. And so really probably the first six weeks is really working on getting your motion. After we get your motion,
then we’re really working on getting that muscle strength back. So for some, getting back
to the gym, two and a half, three months in, is a
very good expectation. Really kinda gettin’ back
to high-level activities, that can range sometimes between the four to six month range, or for some, it can come much quicker. – In a couple minutes, we
want you to hold this thought. We’re gonna come back and talk about this in a couple of minutes, who
should not have this surgery? So hold that thought,
we’ll come back to it. This is really specialized
surgery, I mean there’s only a handful of doctors in
San Diego who do this. – That’s correct, yeah, so my training was specific for this. And this is an area of sports medicine that really is for a few surgeons here that actually practice in San Diego, and really throughout the country itself. With that being said, this is
the fastest-growing segment of sports medicine and for that reason, it has been a very
worthwhile venture for myself and for Scripps in terms of being able to bring that to San Diego. – And how do you know you’re a candidate for this particular type of
arthroscopic hip surgery? – So, again, based on the examination, based on the physical findings, as well as the objective
findings here with your imaging, that can tell us whether
or not you have good, healthy tissue, based upon also in terms of what you wanna get back
to, those are the patients that we’re looking for
in terms of being able to return them back to that healthy state. And so typically it is a younger patient, typically those without arthritis, and those are the ones that
we feel that we’re gonna make the biggest difference to get them back to what they wanna do. – But let’s say you’re a
dancer or you’re a runner, and you have symptoms of pain,
at what point do you say, you know, actually I really need to go see the doctor about this? – If it’s been bothering you enough and it’s keeping you
from what you wanna do, it is that you should probably
be seen by your doctor. The fact is that if you’re
having long-standing hip, that usually is a good telltale sign that there is something
going on within the hip. And to ignore these symptoms, especially in terms of preventing you from what you wanna do, it is time to come back into the office. – But what’s the time frame on that? Cause let’s say you’re an
elite athlete, you know, you’re a runner, you’re
playing soccer, I mean, injuries are part of the
deal, so how do you know, no, actually, is it one week, two weeks, a month, three months? – Well it varies for some. I usually say let pain be your guide. But if it’s not responding
to anti-inflammatories and you feel that it’s keeping
you from what you wanna do, if you’re not able to perform
to the level that you want, it is then that time. – But this kind of surgery is also, I mean you talk about it
being good for younger folks, this surgery also works for
older folks as well doesn’t it? – You’re absolutely right,
so for a select group of patients, especially
for the older group, we do feel that we’re able
to make a big difference. For one, like I had
mentioned, the arthritis, if you don’t have much
arthritis, a lot of times, based upon what we know from the data, this can make a big difference. In addition, we also treat abductor tears, that are actually outside the hip, which we can also do
endoscopically as well. So a number of different
things that we can use from a minimally-invasive
approach, using that arthroscope. – This surgery is really
starting to gain traction because in the last 10 years, I mean, you had arthroscopic surgery
for the shoulder or the knee, and now it’s moving as well to the hip. – That’s correct yeah. So again, this is the
fastest-growing segment of sports medicine and really
based upon the new technology that we’ve been able to
develop in this area. It’s really pushed this field forward. Something else that we
have here at Scripps, which is pretty unique, is
a new Postless Distractor, which is a– – What’s that? (laughs) – Yeah, so one of the big
risks with this procedure is that typically we had
you on a bed with a post, to pull the leg with slight distraction in order to safely access the hip. Sometimes groin numbness was one of the complications related to this. We don’t have that anymore. The fact is that we now have this new bed that’s really just been
released here in the last year. We’re one of the few centers
here on the West Coast, and we have that
available here at Scripps, where we don’t have that complication because of this Postless Distractor, where there is no post between the hips that can lead to that groin
numbness after surgery. – Talk about the new
instruments that offer greater precision, you know,
in terms of the surgery. – Yeah, so with some of the
instruments that we have now, it’s been very nice in
terms of what we can use to access the hip, what
we can use to repair or stitch back the labrum,
and also trim down the bone. So this is all done now where
these are specific instruments that are made specifically for the hip. You had made mention earlier
about shoulder and knee, the very early adopters of
this we’re using those tools. As you can imagine, those were
not really meant for the hip, so now what we have with the
hip arthroscopy instruments, it’s really made it very specific and I think it’s led to better outcomes. – And this is really one of
the fastest-growing areas of sports medicine is it not? – Absolutely, absolutely,
and I think for good reason because we’re starting to
see the real clinical impact and outcomes for those who are coming back to what they wanna do. There wasn’t really a lot of answers for those with hip impingement
or groin pain in the past and so now that we’re able to
address a lot these things, we’ve seen this play out for a number of different weekend warriors,
even professional athletes in terms of getting them back
to a high-functional level. – Okay, let’s come back to this. We referenced this a
couple of minutes ago. Who should not have this surgery? – So outcomes have been
limited for those patients that have advanced arthritis. For those that have advanced arthritis, the cartilage being
degenerative at that point, hip arthroscopy has not been able to make as big of an impact. Those are modest outcomes
that we don’t feel a patient should have to go through in order to get the relief
they’re looking for. A lot of times a hip replacement
is probably better suited for them if they do
have advanced arthritis. – So arthritis is really the key? – Arthritis is the biggest key in terms of what the cartilage looks like. – And what if the injury is really severe? – Yeah, so in certain
cases where the labrum, which is that soft tissue
structure that surrounds the hip, can sometimes be very damaged, and it’s sometimes not even salvageable. So and there are certain situations where we’re not actually able to repair it based upon the tissue
quality and integrity, we’re actually able to replace it with what we call a reconstruction. And those are specific,
specific rare instances where the injury is so bad that we’re able to replace
that tissue as well. – And what would cause these
type of severe injuries? – To some extent, ignoring the symptoms. The fact is, that if
you’ve had these symptoms for a long time, that labrum,
which could have been torn, could be, persistently becoming
more and more degenerative, and so with that, this is
usually long-standing symptoms that contribute to the severe injuries. – Dr. Rebolledo, any final thoughts? – Thank you very much for havin’ me. You know, I’m happy to be here and really share, I think,
this new technology. I think we’ve really been able
to push this field forward and I’m excited to be apart of
this as we move forward here. – The bottom line for
this technology is what? – Less invasive, faster healing, getting you back to what you wanna do. – Thanks so much doctor. Scripps is ranked number one in San Diego and is repeatedly ranked by
U.S. News and World Report as among the best in the
nation for orthopedic care. If you’d like more information
on minimally-invasive hip surgery at Scripps,
just click on the link or go to scripps.org/videos. Want more critical
information about your health? We take care of you from head to toe. Please subscribe to our
Scripps Health YouTube channel and follow us on social
media @ScrippsHealth. I’m Susan Taylor, thanks
so much for joining us. It’s our mission at Scripps
to help you heal, enhance, even save your life.

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