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Melanie Cole (Host):   Hip arthroscopy is a surgical procedure that allows doctors to view the hip joint without making a large incision through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide variety of hip problems. My guest today is Dr. Justin Sherfey. He's an orthopedic surgeon and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Sherfey. I'd like you to start with what are some of the most common hip ailments that you see as an orthopedic surgeon? What are you seeing today?

Dr. Justin Sherfey (Guest):   We have seen a lot of very active people at all different ages, whether they're young high school athlete, collegiate athlete, or kind of the weekend warrior. More and more people are doing different training activities, high level fitness activities and so we are seeing a lot of hip pathology and pain ranging across the ages. Most commonly, people are going to say, "Hey, Doc, you know, I did something and I've got this pain that's kind of in the groin, kind of deep in the hip." That’s kind of hard for them to pinpoint where exactly it is. A lot of times that can be associated with maybe a catch or a lock or some type of popping sensation.

Melanie:   So, these things that they're doing which we think to ourselves are very good to be that active, can some of these be causing some injuries?

Dr. Sherfey:    Yes. Inside the hip joint, I mean, everybody knows that you have this ball and socket inside your hip but around the socket what holds the ball in place is like a suction cup, it’s what’s called the “labarum”. It's a cartilaginous tissue that helps by sealing around the ball and give it some support. With different positions of the hip or activity that can get unhinged or that can get torn and as you age a little bit, it loses elasticity and is more susceptible to get a tear when you're doing some type of high level activity. We see a lot of people that come in and they may have some type of tearing of that labarum. That's a common thing that we're recognizing more and more. Another thing is that the ball and socket are covered with the smooth cartilage surface and you can damage that or have a loose piece floating around that you've broken off from the cartilage. Those are some of the common things that are causing that type of pain with those activities.

Melanie:   When should a person consider seeing a specialist? When it starts to affect their quality of life?

Dr. Sherfey:   Yes. I mean, a lot of times you can have a muscle pull or a little strain and you notice that if you rested for a few days, modify your activity, maybe take some over the counter medicine, that you see a resolve and get back to what you normally live with. So, there's no reason if you have something that just hurts to come right in and I have to see it. If it's getting severe, if you really feel a large lock or pop that’s limiting your motion, or if you just find that the pain is limiting your ability to get back to the activity you want, that's when you should probably seek some professional help.

Melanie:   When would you recommend hip arthroscopy?

Dr. Sherfey:   If we can verify that the hip itself is the cause of pain and that we think that either the labarum or the cartilage is the problem, that's when we start to consider it. Typically, when a patient shows up, we'll take an examination, do a good history, we will get some basic x-rays to make sure the bone looks fine in it; and then, we'll consider a lot of time getting an MRI which will show us those soft parts--the labarum and the cartridge. Occasionally, a lot of times I recommend that the patient actually undergo an injection into the hip first and then we'll see:  did that help a little bit? Did that relieve your symptoms even temporarily? That kind of confirms that the hip is the source of pain and then that can lead us to an arthroscopy which can be very successful.

Melanie:   If somebody has synovitis or dysplasia or one of these kinds of things, would that also be recommended? What is the difference, for listeners, between looking at what you're doing with the arthroscopy and recommending possibly a hip replacement?

Dr. Sherfey:   So, just to touch on your first question, synovitis can be helped. Synovitis is just inflammation of the lining of the joint. Some people get an excessive amount of that and we can go in and remove some of that. Dysplasia is not a very good option for hip arthroscopy. Dysplasia means your acetabulum kind of formed abnormally and going in and addressing some of the labarum can actually make some of those symptoms accelerate. So, it's just that you have to be very cautious in dysplasia. There is some indication for it but it's not a great invitation. So, what hip arthroscopy can offer is basically that this a surgery that's an outpatient surgery. You come in, have it get done anywhere from thirty minutes to an hour and a half depending on what we have to fix and put together. It's done through an average of two or maybe three little poke holes and the camera is inserted into the joint. We can see the entire spectrum of the joint. We don't have to make a large cut and we're not limited by how we enter it. I can move the camera all around in there and it allows us to address most of those issues such as the cartilage and such as the labarum through these smaller working little incisions. It just helps with the recovery if there's a very small incision and it's very amazing of what we can address in there.

Melanie:   After this procedure, what about things like weight bearing and rehabilitation exercises? When do they come into play and is this something that will last a while or is it something you might need to redo in a few years?

Dr. Sherfey:   The recovery is really dependent on what's performed. If you have a procedure where we are just trimming or removing some of the damage tissue, typically, you are going to be sore for about a week. You can get up, put your full weight on it. It may hurt. You may use crutches for a few days but you can advance at your own tolerance. Stitches come out in about two weeks and then people are off on their way. They usually kind of forget about it within six to eight weeks. If you have to have something sewn together, if I have to reattach something to the bone or do a larger procedure, then you're going to be off of it for a little while. Typically, you're on crutches for at least two to four weeks only limiting maybe about half your wait on it, and after about four to six weeks, we start to advance you forward and you're going to take about two to three months to really get back to everything. If it is addressing a particular problem like if we go in and we remove a loose piece of cartridge, we fix the labarum, then you're done. You're back to life and we hope we never have to see you again. If, unfortunately, you have some significant damage and we're kind of just cleaning it up, then you may have some reoccurrence down the road that you may be on your way to maybe something more invasive like a hip replacement or something that's going to resurface or improve the damage that's done.

Melanie:   Dr. Sherfey, are you seeing hip replacements in the younger population?

Dr. Sherfey:   Yes, we are. I mean, we still try to get you down as far as we can because even though we have a lot of new technology and technique that makes hip replacements very successful in the younger patients, you still are young and your activity level is going to wear it out faster. A lot of the data we have of how long a hip lasts is in a 70-year-olds and so we know that it should last “x” amount of years but you put it in someone who's under the age of 40 and it's kind of like driving your car. You are going to put more miles on your tires and you're going to wear it out quicker. So, even despite some of our advancements, there are still some disadvantages in a young patient. However, I will say though in the last ten years, the percentage of people under 65 that are getting hip replacement has probably at least doubled and we're seeing a lot of success in that as the technology and procedures have improved.

Melanie:   Wrap it up for us with your best advice for people suffering with hip pain, chronic or a little bit more acute--something that just sort of started for them; and what you want them to know about dealing with that hip pain, the first line of defense for it; and then, when they should probably see a specialist and consider a procedure?

Dr. Sherfey:   As I mentioned earlier, if you are having some hip pain, just modify your activity and give it a few days of rest. If you don't have any reason or issues with taking over the counter medicine, you could give that a try. If you find that it's not improving or if it is worsening, you should then seek your primary doctor or an orthopedic specialist to take a look at that. If you have an injury, a major type injury, and instantly you can't walk on it and can't put weight on it, if it's significantly painful, you probably want to seek attention on that a little quicker. I wouldn't wait more than maybe overnight if you just hurt it and wanted to see how it felt the next morning but if it is significant you should probably get it looked at a little quicker.

Melanie:   Dr. Sherfey, why should they come to Palmdale Regional Medical Center for their care?

Dr. Sherfey:   Palmdale Regional Hospital is a specialized hospital. It's multi-disciplinary. It has a very well trained staff that are going to care for your patient with compassion and empathy. You're going to get high quality physician. They have excellent facilities to provide good quality care. Patient satisfaction is very high there and you're going to get very good treatment.

Melanie:   Thank you so much for being with us today, Dr. Sherfey. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to www.palmdaleregional.com. That's www.palmdaleregional.com. Physicians or independent practitioners who are not employees or agents of Palmdale Regional Medical Center the hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.