Hip Preservation
General Info

History of Hip Preservation

1913 Vulpius described cam osteoplasty

1926 Keys – Osteoplasty in severe SCFE did very poorly

1931 Burman in New York performed hip arthroscopy in cadavers

1933 Elmslie cam and pincer can cause OA

1935 Smith Peterson – pincer impingement and rim trimming

1935 Heyman & Herndon – SCFE osteoplasty

1939 Takagi first clinical use of hip arthroscopy

1965 Murray – Tilt deformity and hip dysplasia cause most of the OA

1975 Stulberg & Harris – pistol grip deformity. No primary OA.

1976 Solomon – 92% of OA is from childhood disorders or inflammatory arthritis

1977 Altenberg – Acetabular labral tears causing hip pain

1980 Suziki – first arthroscopic diagnosis of acetabular labral tear

1987 James Glick – hip arthroscopy in lateral position

2001 Michael Dienst – Hip arthroscopy without traction

2009 Voos – Peritrochanteric space endoscopy

Open reduction of dislocated hips, osteotomies for dysplasia, and Chielectomy for Perthes are well known. Murray, Harris, Stulberg recognized that the so-called primary osteoarthritis of the hip is usually secondary to congenital and developmental conditions.

Reinhold Ganz

    • Periacetabular Osteotomy for dysplasia in 1987
    • Found pain from over coverage in 5 hips – Impingement. 1995
    • Developed safe surgical dislocation and studied damage patterns. 2001
    • Added rim trimming, femoral neck osteoplasty, and labral repair.
    • Modified Dunn & Colonna procedures and developed head reduction osteotomy.

Dr. Prasad Gourineni visited Ganz’s unit in Bern in 1998 when surgical dislocation was being done and cam and pincer FAI were being treated. On return to Chicago, he talked about radiographic abnormalities and FAI to the US arthroscopists at their course for two years. They caught on fast and developed arthroscopic techniques to treat FAI and added FAI induced instability, micro instability, capsular plication, capsulorraphy, sub spine impingement, and association of FAI with a sports hernia, osteitis pubis, SI dysfunction, muscle strains, and traumatic dislocation.

Most hip preservation procedures we do today do not make future total hips too difficult. We don’t create new deformities or decrease bone stock. Of course the scar makes the dissection difficult and MIS is not possible. Multiple procedures do increase the risk of infection.

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