A crushed ankle and a damaged hip. That was the reality that Jonathan H., 22, faced one year ago this month after suffering a motorcycle accident in San Diego. He was rushed to a local hospital where they immediately performed surgery on him to repair the critical damage. The bones mended, but the pain remained.
“The doctor told me that after six months, I should be well enough to go back to work,” Jonathan said. “But my ankle and hip were still killing me, still very painful.”
Jonathan still didn’t feel well enough to work, so he sought out a second opinion and found his way to Dr. Harish Hosalkar, a highly respected orthopedic surgeon who is affiliated with the San Diego Spine & Joint Center at Paradise Valley Hospital. Dr. Hosalkar specializes in pediatric, adolescent, and adult hip preservation and reconstruction, deformity correction, limb reconstruction, and orthopedic trauma.
After meeting with Jonathan, Dr. Hosalkar suspected a tear in the acetabular labrum, the cartilage that seals and protects the ball-and-socket hip joint. The labrum also acts as a shock absorber for the hip, which is a major weight-bearing joint. If the labrum is damaged and torn following injury, as in the case of Jonathan, this can cause severe pain and even more damage to the affected area over time. A subsequent scan performed on Jonathan, a magnetic resonance arthrogram, confirmed Dr. Hosalkar’s diagnosis.
Dr. Hosalkar and Jonathan decided to first try non-surgical solutions, including modified activities, anti-inflammatory medications, physical therapy and a regimen of three platelet-rich plasma (PRP) injections. PRP is the plasma isolated from a patient’s own blood enriched with a higher concentration of platelets and other factors, which are known to play a role in tissue healing. However, Jonathan’s traumatic labral tear proved too extensive for these conservative approaches. He had suffered a three-centimeter tear in the anterio-superior labrum with detachment.
They decided that their only recourse would be hip-preservation surgery. Because Jonathan’s ankle injury was on the same side as his injured hip, Dr. Hosalkar felt he wouldn’t be able to perform traditional pure arthroscopic hip surgery on a traction table, where sustained longitudinal traction is applied on the leg to “sub-luxate” the hip (pull the ball-joint out of the hip socket) for several hours.
Instead, Dr. Hosalkar used a “small incision”-lateral approach with trochanteric-flip and arthroscopically assisted labral repair. With this technique, there is no need to keep Jonathan in sustained traction. Consequently, Jonathan was able to move his hip right after surgery on a contained passive movement (CPM) rehabilitation machine while he was still recovering in the hospital, and was able to start his physical therapy regimen in less than a day.
His post-surgical pain was managed with a multimodal approach by Paradise Valley Hospital’s pain management team, including the use of liposomal bupivacaine, a long-lasting local anesthetic. This provided Jonathan with excellent pain-management results.
Dr. Hosalkar successfully performed the surgery in March and, today, after a few months of diligently following Dr. Hosalkar’s rehabilitation regimen, Jonathan is satisfied with his outcome. “The rehab took longer than I liked,” said Jonathan, “but it’s absolutely worth it! I feel no pain or strain on my hip at all. Sometimes I forget that my hip was injured in the first place!”
Jonathan credits Dr. Hosalkar and his hospital healthcare team. “Everyone, from the doctors, staff and therapists were wonderful! I can’t say enough good things about the Spine & Joint Center!”