Lessons in the Elite Athlete: How I've Evolved My Hip Practice J. W . W. . Thomas By Byrd, MD MD Hip Pr Preser ervati tion f for L Life Orthop thopae aedic S c Summit 2 t 2017 17 - Evolving ng T Techni hniques ues Las Las Vegas as, N Nevad ada Decem ecember er 8 th th , 201 2017
• “He w e who d desi sires s to prac actice ce sur urgery mus must go o to o wa war” – Hippocr crates tes
• “No bette tter c clin linic ical la l laboratory than the f fie ield lds of athle letic ic c competitio ition”
Arthroscopy: The Journal of Arthroscopic and Related Surgery 10(3), 1994:275-280 Hip Arthroscopy Utilizing the Supine Position J. W. Thomas Byrd, MD
"Hip p arthros throscop opy i is a triumph ph of of te technique ov over rea r reason... The There i is no no pl place for for it. t." -1997 -2002
NFL Physicians Society Sports Science Symposium, 1999 Persistent Hip Pain in an Offensive Lineman J. W. Thomas Byrd, MD
Clinics in Sports Medicine 20(4), 2001: 749-762 Hip Arthroscopy in Athletes J. W. Thomas Byrd, MD, Kay S. Jones, MSN, RN
Clinics in Sports Medicine 20(4), 2001: 749-762 Hip Arthroscopy in Athletes J. W. Thomas Byrd, MD, Kay S. Jones, MSN, RN • Me Mean im improvement 3 t 35 p poin ints ts • 93% 93% dem emonstrated > > 10 10 p pt t improveme ment nt
Results ts 100 80 60 Score re 40 20 0 0 1 3 6 12 24 60 Months nths
Am J Sports Med, 2009; 37(11): 2140-2143. Hip Arthroscopy in Athletes: 10-Year Follow-up J. W. Thomas Byrd, M.D. Kay S. Jones, M.S.N., R.N.
Am J Sports Med, 2010; 37(11): 2140-2143. Hip Arthroscopy in Athletes: 10-Year Follow-up J. W. Thomas Byrd, M.D. Kay S. Jones, M.S.N., R.N. • Median an i improvement 45p 5pts • 87% 87% r ret eturn to to sp sport • 33% 33% co converted t to THA a at ave. 6 6 yr yrs – Du Durabi bility o of results u uncer ertain
Clinical Orthopaedics and Related Research 417, 2003:112-120 Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA
Am J Sports Med , 2011 Jul; 39 Suppl; 7S-13S Arthroscopic Management of FAI in Athletes J. W. Thomas Byrd, MD Kay S. Jones, MSN, RN
FAI Athletes etes • 200 A Athle letes w wit ith F FAI – Median an improvem vement 24pts s ( preop 72 p 96 ) p 72; posto top 9 • 16p 6pts ts: B Bipo polar c chondr dral d damage age – 49 Mic Microfx’s ’s: Me Median improve vemen ent 2 26p 6pts s
FAI Athletes etes • 200 A Athle letes w wit ith F FAI – 181 ( 1 ( 90% 0%) Retur urne ned t to s sport • 95% 5% p profe fessional • 85% 5% co collegi giate
FAI Athletes etes • 200 A Athle letes w wit ith F FAI – Complic licatio tions: • 5 tr transient n t neuropr praxias ( ( all r reso solve ved ully ) unev eventf entful • 1 mild ild HO HO ( no tx on outcome ) no tx; no ef no effect on out – On One ( ( 0.5% 5% ) c conver verted t to THA – Four Four ( ( 2% ) r repeat at a arthrosco scopy y
Unique considerations of treating Elite Athletes
Ex Exceptions tha that I make i in n how how I tr treat El Elite te A Athl thletes –Be careful w when ma making g except ptions t to norma rmal l standa dards ds o of care!
Exce cepti tions? • Excep epti tions ons are re re reali lity • Much m uch mor ore ti e time/ e/resou ources to to dedica icate t te to recov overy ery • Highly hly m motivated ated – Can ma n make y you ou look ook good ood • By d defini inition, tion, h have h e high p pain in toleran rance ce – Good & d & Ba Bad
Exce cepti tions?
Exce cepti tions? “R “Reme membe ber, y you d don’t p pla lay foot ootball f for or y your our heal health th” Crai raig D. Bri righam, MD MD
Exce cepti tions? • Athlet letes es have f fin init ite lif life o of compe mpetitive a athle letic c care reer – Qu Quic ickly ly c clo losin ing w win indow of opportu tunity ty to gener erat ate subst stantial al i income – May c choo hoose to o be s shor hort s sighted f for or econ onom omic ic r reasons ons • But i t it t must t be informed d d dec ecision o on th their part – May a y apply t y to professi ssional al / / elite e / schola olarshi hip / possib ibly h high s school ool athletes es
By the t time athl hlete te lands nds on m on my door doorstep, unlik likely ly t the h hip ip will ill ever be be r returned d to to norm normal
My doorste My tep • Can d do ma many t thin ings gs t to dimin iminish sympto toms & & perhap haps i improv ove e long ongevity of of joi oint nt, b but can ut can nev never tru ruly re restore n nativ ive v vir irgin gin h hip ip
My doorste My tep • Earlier r ier recogniti nition o on of patho holog logy ma may b be helpf lpful – Perhap aps e ear arlier er i inter erve vention m may lead ad to improve ved r resu sults • Earli rlier re recogn gnitio ion o of hip ips “a “at ris risk” is is crit ritical – Mo Modific icatio tion o of train inin ing programs and c counse seling m may l y lead ad t to bet etter er prevent ntion on
Our s surgical s ical solutions tions a are imper erfect ect – Future is is in in Or Orthobio iolo logics
Recommend
More recommend
