Until recently, if you were young or middle-aged and had pain in your hip or groin, you didn’t have many options. Your doctor would probably offer painkillers, physiotherapy, offering an explanation that ‘you’re too young for a hip replacement’. Lots of people have had to put their lives on hold because there was nothing that could be done to effectively diagnose their problem, let alone treat it. If you are in this position, then it may seem like there is no light at the end of the tunnel. But now, Professor Griffin and his team are changing that by returning young adults suffering from hip problems to fully active lives.
‘For a long time I’d been intrigued as to why some people develop pain in their hips at a young age’, says Professor Griffin about his interest on the subject of preservation surgery. ‘Some surgeons specialise in knee or shoulder surgery: I decided to focus exclusively on younger adults with hip pain.’
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Focus on the diagnosis
‘Our first problem was to work out how to make a really precise diagnosis. This begins with a detailed discussion to understand the problem, whether it has developed over years or come on suddenly as the result of a sports injury. A specialist physiotherapist and I perform careful physical examinations, comparing our findings. Then most people will need a variety of scans.’
‘With some of the most advanced imaging equipment in the country, we’ve developed scanning protocols that give us incredible pictures of the inside of the hip. We can see fine details of the shapes of the bones that form the ball and socket, the cartilage that lines the joint and the rubbery labrum that forms the rim of the socket. Many people travel a long way to see us, so usually we’ll do all of this in a one-stop clinic.’
‘It is tremendously rewarding to draw all this information together and to be able to fully explain to someone what is happening to their hip, often after years of uncertainty and frustration.’
‘Surgery isn’t always necessary: often we can reassure people and show them how exercises and rehabilitation can get them back to normal. At the other end of the spectrum, the hip is sometimes so worn that a hip replacement or resurfacing is the only option. For those people we have developed special muscle-sparing and minimally invasive techniques like Direct Anterior and SuperPath approaches that allow rapid recovery and return to sport. But in many of our patients, the best way forward is joint-preserving surgery—an operation to try to rescue the natural hip, relieving pain and improving function.’
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Keyhole surgery
Professor Griffin has been a leader in the development of arthroscopic or keyhole hip surgery. Working with an international group of innovative surgeons, and regularly lecturing all over the world, he has developed techniques that allow him to perform a remarkable range of operations through tiny incisions; allowing young adults suffering from hip problems to recover far more quickly than with conventional surgery.
‘Our idea is to work inside the hip while doing as little damage as possible to the muscles and ligaments that surround it,’ he says. ‘At first, this was really difficult because, compared to joints such as the knee or shoulder, the hip is deep inside.
‘With the patient asleep, we have to use X-ray imaging to help us find our way safely in between the ball and the socket, and insert a camera so we can see all around the hip. In our hospitals, we are very lucky to have two operating theatres that we specially designed to make this particular operation as safe and easy as possible. Once inside, we can find our way around using a map of images and 3-D models of that person’s hip. Tiny instruments can be inserted through one-centimeter incisions to remove loose fragments, repair cartilage, stitch ligaments or reshape bone.
‘Although I still sometimes use conventional open surgery, I much prefer hip arthroscopy. Because of the magnification of the camera on a big screen, I can be very precise and the keyhole technique means that patients recover very quickly. Almost all will get out of bed and walk on the day of their surgery, and most will have a session in the gym working with a physiotherapist on an exercise bike on the afternoon of their operation. In fact, we think that rehabilitation is so important that we want to start straight away!’
A brighter future
Professor Griffin says that he can’t yet see what the limits of hip arthroscopy and preservation surgery will be for young adults suffering from hip problems. ‘We’ve learned so much and moved on so quickly in the last few years,’ he says. ‘For example, we now understand that lots of people’s hips are not quite round; a condition we call femoroacetabular impingement syndrome. This has turned out to be the cause of most labral tears and, I think, is probably the cause of most young adults suffering from premature arthritis in the hip.
‘Now we can correct FAI syndrome by reshaping the ball and socket to make them fit. We’ve learned that many people with troublesome hip problems that interfere with everyday activities can be cured with surgery for relatively straightforward problems such as labral tears. We’ve learned that many cases of ‘groin strain’ in athletes and footballers are really hip joint injuries, and that they can be repaired.’
But, Professor Griffin has his eye on the future. ‘The real prize is to develop techniques to repair the smooth cartilage lining that wears out in arthritis,’ he explains. ‘Then we can rescue young and active people’s hips from wear and tear, or injury, and prevent them from deteriorating enough to need a hip replacement.
‘It will take years, but with a new approach to hip surgery, and new technologies like arthroscopic surgery, cartilage repair and stem cell implantation, I am confident that we will greatly reduce the need for artificial hips in young adults suffering from these conditions.’
Hip arthroscopy can benefit:
- Teenagers through to people in their fifties
- People with hip or groin pain that interferes with work, sport or their everyday life
- Symptoms such as pain on exercise or certain movements, including clicking, catching, locking or giving way
Get in touch…
Professor Damian Griffin runs a hip preservation clinic at the BMI Meriden Hospital in Coventry, where a new state-of-the-art hip arthroscopy operating theatre has just been opened. To find out more about his work for young adults suffering from hip problems, visit hiparthroscopyclinic.co.uk or to make an appointment, call his private secretary, Emma Whitley, on 01926 403529.
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