Dr. Dustin Woyski

Anterior Hip Foundation 2024

It’s important to ask your surgeon if they use a post or are a post-less hip arthroscopist. Head-to-head it makes a difference on your outcome and pain level!!

This article highlights the importance of proper technique during hip arthroscopy. You should be asking your surgeon 1) how often are you doing labral debridement vs repair? This should be overwhelmingly a repair. 2) how often do you perform labral reconstructions? A proper functioning labrum is critical to outcome. Your hip deserves a surgeon who is comfortable with labral reconstructions in a primary and revision setting. 3) do you close the capsule? To me this is a red flag. Capsule management and repair are pivotal in the long-term outcome of your hip. A yes answer to these questions can be the difference between a 3 and 30% chance of having your hip replaced at 10 years!!!

This article stresses how important proper technique is with hip arthroscopy. It’s important to ask your surgeon if they perform labral debridement vs repair? How often are they performing labral reconstructions? Do they perform capsule repairs? These answers are important for your long term outcome of needing a hip replacement!!

Paying attention to fixation principles is paramount to avoid catastrophe. Thankfully arthroplasty can often times come in and save the day when disaster strikes. Patient hadn’t been able to walk for 3 months since their initial injury. Was walking with a walker the day of surgery.

Subtrochanteric femur fractures can be difficult to reduce and fix given the muscle forces acting on the fragments. My preferred technique is a traction pin, K-bow and weights to hold reduction but allow manipulation of the leg to reduce the length of time on the struggle bus 🚌 🦴 🔨

Subtrochanteric femur fractures can be difficult to fix given muscle forces acting on the broken fragments. Traction pin, K-bow and some weight can help reduce the fracture but allow manipulation of the leg and significantly reduce the ride on the struggle bus. 🚌 🦴 🔨

Been a while since I’ve seen one ground through the subchondral bone. Poor patient hadn’t been able to walk for nearly a year.

Time for the holidays with

Capsule closure during is essential for optimum outcomes. Make sure your surgeon is a

Another edition of Hip Makeover Monday. This is a recent patient with 10+ years of hip pain. Unfortunately has moderate hip dysplasia but thankfully the cartilage is intact. You can see the top of the joint is angled up and the socket does not cover the hip ball very well (indicated by something called lateral center edge angle; here it’s 7.5 deg and normal is 25-40deg)

They underwent a procedure called a periacetabular osteotomy or PAO. This procedure makes precise cuts (controlled intentional fractures) around the acetabulum (socket) that allows us to move the socket to a better position. It’s then fixed or held in places with multiple large screws.

Now their socket is well-aligned, is no longer angled up but is nearly flat and has better coverage of the ball with a normal center edge angle of 32 deg. They also underwent a hip arthroscopic labral repair prior to the PAO under the same anesthetic and without moving tables.

My feeble attempt to explain the two-slit experiment to my 9 year old. He did say “that’s crazy!!” At the end, so maybe I did an ok job.

“Hip Makeover Monday” a multiply operated hip presents many challenges. One of which is diminutive labral tissue that can’t serve its function, by providing a duction seal for the hip joint. allows us to make a new labrum out of graft tissue and customize the size. Thus restoring the suction seal. If you’re considering revision make sure your surgeon is experienced in labral reconstruction.

In this episode of lessons in frugality:
Climate control doesn’t work and is stuck at 60F. Original plan was a blanket and some gloves for this winter but realized I needed defrost. Original estimate was $300 labor and $1400 for a new part 😳 too rich for my blood!! Realized there’s online salvage shops. Found 2 of them for $80 a piece (hey I’m also paranoid). Labor ended up only being $160 and viola saved nearly $1400 **er

Post #2 of labral reconstruction with capsule reconstruction for instability

1) labral graft. I prefer to use tensor fascia lata allograft but can use other soft tissue grafts. This is cut to length, tubularized and prepped for shuttling into the hip joint

2) Labral graft is in position and now the medial and lateral anchors can be tied in order to secure the ends. Then it’s just like a regular labral repair!

3) Graft now completely secured. I typically will pass an absorbable suture through each end to secure the end of the graft to intact labrum.

4) The suture storm begins!! Two anchors go into either side of the subspine, then an anchor at each end (medial and lateral) of the acetabulum corresponding to length of defect. I will pass a suture at each corner of the intact capsule, and 2-3 in the distal intact limb depending on defect size. Once anchors are positioned I switch to an open approach to pass sutures through the graft, shuttle the graft and secure the graft.

5) 3.5mm thick dermal allograft cut to size. This was a large defect to cover.

6) Can see the labral reconstruction as well as some of the sutures in the subspine. Also appreciated is the size of the defect.

7) The suture storm through the graft. This whole case can be done arthroscopically but I think I get better suture passage, tying of sutures and ease of graft passage through an open approach.

8) Final product with capsular reconstruction graft secured!!

This patient is wary in recovery but stated at their two week appointment that they have very little pain and their hip already feels better than prior to surgery and much more stable 😁

can be very painful

Being able to perform a hip arthroscopy on a postless table then seamlessly convert to a periacetabular osteotomy (PAO) has great benefits. The patient is under one anesthetic, more efficient, decreased risk from a bed transfer, etc.

Deficiency of the iliofemoral ligament or termed “capsular defect” can result in leading to increased pain. The tell tale subjective finding is “my hip hurts worse since my hip scope”. On physical exam patients have pain in multiple locations including groin, can have iliopsoas irritation and may have excessive external rotation of their affected leg. Capsule reconstruction helps restore stability to the hip and offers pain relief and increased function to severely debilitated patient group.

Brief article about periacetabular osteotomies now being performed at North Kansas City Hospital.

https://www.nkch.org/for-providers/newsletter/physician-connections-articles/past-issues/2021/nov-dec-2021/hip-dysplasia-preservation-surgery-restores-function?utm_source=ActiveCampaign&utm_medium=email&utm_content=Physician+Connections+Nov%2FDec+2021&utm_campaign=PhysicianConnections_Nov%2FDec+2021_NPL

Hip Dysplasia Preservation Surgery Restores Function When conservative management of hip dysplasia fails, NKCH's Dustin Woyski, DO, performs periacetabular osteotomy, or PAO, to improve function in the hip joint and preserve the natural hip.

Was an amazing opportunity to train at Duke and learn this state of the art technique!!

https://physicians.dukehealth.org/articles/postless-hip-distraction-system-contributes-less-pain-fewer-complications

Postless Hip Distraction System Contributes to Less Pain, Fewer Complications Duke specialists highlight two innovative techniques for hip preservation surgery

Hip dysplasia can be a cause of hip pain in kids and young adults. Often treated with a periacetabular osteotomy. Find out more in my blog post below. https://www.northlandosm.com/blog/hip-dysplasia-and-periacetabular-osteotomy

Hip Dysplasia and Periacetabular Osteotomy: Northland Orthopedics & Sports Medicine: Hip dysplasia is a continuum of disease that can present itself early in life as an infant or much later into adulthood as hip pain and or arthritis. Dr. Woyski

Pain on the side of your hip is extremely common. Often times it’s due to limping or muscle weakness, but other times it can be an indication of something more sinister.
https://www.northlandosm.com/blog/gluteus-medius-abductor-tear

Gluteus Medius (Abductor Tear): Northland Orthopedics & Sports Medicine: Gluteus medius and/minimus or commonly known as abductor tears, can be painful and debilitating. Dr. Woyski reviews their common symptoms and select treatments.