AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-When Enough is Enough – The Role of THA After Failed Hip Preservation Surgery with Radiographic Joint Preservation-Joel Matta, MD

When Enough is Enough – The Role of THA After Failed Hip Preservation Surgery with Radiographic Joint Preservation-Joel Matta, MD

Back to course

Pdf Summary

This presentation by Dr. Joel M. Matta focuses on the challenges and considerations of performing Total Hip Arthroplasty (THA) for patients with painful, non-arthritic hips who have previously undergone failed hip-preserving surgeries such as arthroscopies or periacetabular osteotomies (PAO). Dr. Matta emphasizes always using the anterior approach for THA in these cases, noting it is especially important when converting from prior surgical approaches.<br /><br />Key points include critical patient evaluation to determine the true source of hip pain, which may not always be mechanical or articular in origin but can involve capsular, muscular, or inflammatory components. A thorough preoperative history and physical examination are vital, as over-reliance on imaging like X-rays and MRIs can mislead treatment decisions. The better the radiograph looks preoperatively, paradoxically, the less predictable the postoperative outcome, especially if the patient has long-term narcotic use, which negatively affects surgical success.<br /><br />Dr. Matta highlights common pitfalls such as surgeon errors, including attributing all hip pain to mechanical causes and not considering broader diagnoses, including inflammatory joint disease or psychosocial factors. He also points out the importance of limiting narcotic use to acute situations to avoid poor outcomes.<br /><br />Additional considerations include addressing adolescent and young adult patients with complex psychosocial issues like rapid onset gender dysphoria (ROGD), which may complicate the clinical picture.<br /><br />For patients undergoing THA after PAO, Dr. Matta notes the need for acetabular bone grafting and recommends prior incision sites, such as Smith-Petersen or "bikini" approaches, to facilitate surgery and screw removal.<br /><br />Finally, Dr. Matta underscores holistic care, including diet (advocating Paleo diet principles) and exercise, as part of overall hip health management. The presentation calls for realistic expectations, careful patient selection, and comprehensive management strategies to improve outcomes in this challenging patient population.

Keywords

Total Hip Arthroplasty

Anterior Approach

Failed Hip-Preserving Surgery

Hip Pain Evaluation

Capsular and Muscular Pain

Narcotic Use Impact

Psychosocial Factors

Periacetabular Osteotomy

Acetabular Bone Grafting

Holistic Hip Care