Hip

The hip is a highly constrained ball and socket joint linking the upper and lower extremities.  As a result, it endures incredibly high forces and, in addition to arthritic wear and tear, athletic injuries of the hip can be devastating to elite athletes.

Click the links to explore the types of hip surgeries Drs. Knesek and Silas perform.

Total Hip Replacement

What are common symptoms of hip arthritis?

Arthritic pain is typically gradual and progressive but some patients do experience relatively rapid onset of symptoms, including:

  • Pain in the groin or front of the hip with occasional radiation of pain down the thigh
  • Loss of mobility inability to stretch and rotate the hip
  • Increased pain with increased activity
  • Nighttime aching in hip
  • Progressive limping

What are my options for treating my hip arthritis other than surgery?

Depending on the severity of the arthritis and how much it interferes with your function, a variety of treatments are used for management of symptoms: 

  • Tylenol or Anti-inflammatory medications such as Ibuprofen and Naproxen
  • Physical therapy in certain patients
  • Weight loss can reduce the strain on the joint, therefore diminishing symptoms
  • Injections of cortisone into the hip joint can provide temporary relief
  • Platelet-rich plasma and/or stem cell injections in appropriate patients. 

When do I need a hip replacement?

In advanced arthritis or when other treatments are ineffective, a hip replacement is recommended in which the arthritic ball and socket are replaced with metal and polyethylene components.  While this is a significant operation, it is also a very straightforward and successful operation for Dr.Knesek who has advanced fellowship training in Adult Reconstruction and is one of the highest-volume hip and knee surgeons in the state.

What is the recovery like after hip replacement?

Many patients go home the next day and some are now being done as an outpatient or same-day surgery.  You will walk the afternoon after your surgery and typically most of your arthritic pain resolves during the first several weeks of recovery.  Golf, tennis and low-impact exercise are all permitted and encouraged after hip replacement.

Anterior Total Hip Replacement

What is Anterior Hip Replacement?

Anterior hip replacement is a revolutionary surgical technique in which Dr. Knesek goes between the muscles on the front of the hip rather than through the muscles on the side or back of the hip. 

What are the advantages of Anterior Hip Replacement?

This approach is less invasive both in terms of a smaller incision and far less trauma to the muscles around the hip.  This significantly reduces the pain and muscle recovery needed after surgery resulting in an accelerated and less painful recovery.  Additionally, the risk of artificial hip dislocation is much lower with this approach than traditional approaches. 

What occurs during Anterior Hip Replacement?

Hip replacement involves the removal of the arthritic ball of the hip joint and replacement with a metal or ceramic ball.  The socket is then surgically smoothed and then resurfaced with a metal or polyethylene cup.  Results in terms of diminished pain and increased function are excellent.  This is typically done in the hospital although outpatient hip replacement is actively being developed by our team. 

If this is such a groundbreaking procedure, why aren’t all hip replacements Anterior?

There are certain patient factors such as previous surgery, certain types of deformity, and obesity which can require a more traditional approach rather than Anterior.

There are also surgeon factors as Anterior Hip Replacement is considered a more technically difficult procedure to perform and requires special training.  Dr. Knesek is one of the few physicians at Ascension Providence with fellowship training in hip and knee replacement surgery, and has performed the most Anterior Hip Replacements at Ascension Providence since he was recruited from DMC. 

Femoracetabular Impingement/ Hip Arthroscopy

What is Femoroacetabular impingement (FAI)?

FAI is a condition in which abnormal shape or bone formation in the hip leads to a “pinching” between the ball and the socket.  This can occur due to too much bone on the femur/ball or a sharp edge on the acetabulum/socket.  This is most common in younger, athletic people with women more commonly having the “pincer” deformity on the socket and men more commonly having the “cam” deformity on the ball.  Over time, this can lead to damage to the labrum which is the “O-ring” of the hip joint.  

What are the Symptoms?

Most common complaints are frontal hip or groin pain particularly after physical activity or sitting for long periods of time (car travel).  Many patients experience a sense of stiffness or fullness in the hip, particularly when putting socks or shoes on.  

How is it Treated?

FAI is initially treated with therapy and injections but if it appears structural damage is occurring or you are not improving with nonsurgical management of the problem, hip arthroscopy is a highly successful way of treating this problem. The decision to consider surgery depends in part on your response to therapy as well as the severity of your hip pathology for which an MRI is typically obtained.

What type of surgery is Recommended for FAI?

Dr. Silas may recommend hip arthroscopy to treat your FAI.  Arthroscopic treatment of hip disorders has evolved dramatically in the last 10 years and this less invasive procedure allows us to reshape the ball and the cup to treat FAI.  Timely treatment can prevent premature development of hip arthritis.  Labral tears can be treated with direct arthroscopic repair techniques or with labral reconstruction which requires a donor graft to reconstruct the labrum.  Dr. Silas has been on the leading edge of this revolution in surgical treatment of hip pain and is one of the few surgeons in Michigan performing not only hip arthroscopy but complete labral reconstruction.  She sees many patients in the Midwest who have had a prior unsuccessful hip arthroscopy or who have irreparable damage of their labrum. Our goal with all patients is to preserve your native joint, however in some patients with advanced arthritis, hip arthroscopy may not help. In these patients, a total hip replacement is an excellent option for eliminating pain and restoring function. 

Arthroscopic Labral Reconstruction

What is Arthroscopic Labral Reconstruction of the Hip?

The hip is a ball and socket joint with a hard-rubbery “O-ring” known as the labrum that provides stability and seals the hip joint. Preservation of the hip labrum has been increasingly identified as vital to preservation of the hip joint, maintenance of an active lifestyle and avoidance of hip replacement.  In the early years of hip arthroscopy, our abilities were limited to removal of damaged labral tissue which was an excellent short-term solution but its results did not stand up to longer term improvement.  Hip arthroscopists began to innovate methods of repairing rather than removing the labrum.  This requires the labral tissue to be healthy with a well-maintained blood supply; when these factors are favorable, repair of the acetabular (hip socket) labrum is typically highly successful.

Dr. Silas and other hip surgeons now recognize a subset of patients who have little arthritis but very poor labral tissue.  In these patients, simple removal of the labrum could accelerate the development of arthritis but the tissue is too poor to perform an adequate repair.  In fact, simple removal of labral tissue is a leading cause of failed hip arthroscopy–it is also one of the most common reasons patients are referred to her. She now is one of the few surgeons in Michigan to preserve the hip joint by way of a reconstruction of the labrum.  

What type of surgery is Labral Reconstruction?

In these procedures, donor tissue is fashioned into a labrum and inserted and secured to the hip socket arthroscopically. This is an outpatient surgery done through small, arthroscopic incisions.  The recovery requires several weeks of crutches and full recovery takes several months but the restoration of normal hip anatomy in those with poor labral tissue can add years to the lifespan of the hip joint.

Am I a candidate for Labral Reconstruction of the Hip?

For simpler tears of the labrum, repair of your native labrum may be the best option.  However, if your tissue is poor, labral reconstruction is an excellent option.  Frequently, the decision to repair or reconstruct is an intraoperative decision.  Fortunately Dr. Silas is one of the few hip surgeons in Michigan performing both types of procedures and she will perform whichever option will be best for the longterm health of your hip.

Our goal with all patients is to preserve their hip joint. In some situations the severity of arthritis makes this impossible. For these patients, a total hip replacement is an excellent option for eliminating pain and restoring function.