Inside the OR: Hip preservation at Vincera Institute

Functional movements in sports constantly place demand on the core and hip, making the condition of these parts essential for peak performance. Luckily, in Philadelphia’s own Navy Yard, the

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brings together some of the nation’s leading physicians, therapists and trainers to create a one-of-a kind integrated hip and core injury center.

Founded by renowned physician Dr. William C. Meyers, the 34,000-square-foot facility includes a physicians' clinic, surgery center, rehabilitation space, yoga studio, imaging, acupuncture, and nutrition center all under one roof.

In the past 25 years, Meyers has performed more than 18,000 core muscle repair procedures, and his patient list reads like a who's who of professional athletes: Donovan McNabb, Brent Celek, Adrian Peterson, Danny Briere, Miguel Cabrera, Greg Jennings, plus scores of high school and college athletes.

For many of these athletes, the core injuries often go hand-in-hand with issues related to hip pathology. That's where Rothman Institute's Dr. John J. Salvo Jr. comes in.

Salvo is one of the region's leaders in hip arthroscopy, especially in athletes. Together with Dr. Struan Coleman from Hospital for Special Surgery in New York City, they co-direct the Hip Preservation Center at Vincera.

Hip pathology is often the result of genetics. But for athletes, especially those who start practicing at a young age, developmental issues come into play.

"Bone is a dynamic structure that responds to stress so when you're a growing kid and you're doing rotational impact sports, especially with kids doing it year round now, that bone is going to react and reform and most likely cause an impingement," said Salvo.

"For athletes that have both core and hip injuries, sometimes you can treat one injury and the symptoms of the other will get better, but many times we have to treat both," said Salvo.

"The core muscle issue is usually due to an actual injury — the athlete twists or hits it awkwardly and that sets off muscular symptoms and the pain starts."

However, in the hip, things are usually attritional. The patient may have experienced something that set off symptoms but their true pathology had been cooking for a long time.

Traditionally, doctors would treat the issues at two separate surgical settings. Yet, at Vincera, they address the injuries in one fell swoop, something very few surgical centers in the country offer.

"We've seen much better success with patients that have both pathologies, when we fix them both in the same setting," said Salvo. "Once Dr. Meyers is done with the core injury, we can get inside the hip arthroscopically with two or three small incisions and basically correct all of the pathology that has been cooking inside for years and years."

Using hip arthroscopy, the surgeon makes small portals and uses a camera and surgical tools to address issues in the hip, most commonly femoral acetabular impingement (FAI) and labral debridement/repairs.

A 2013 study showed that the utilization of hip arthroscopy by candidates of the American Board of Orthopaedic Surgery increased by 600 percent from 2006 to 2010.

FAI decompression involves shaving down bone where the neck of the ball (femoral neck) pinches on the socket. For a torn labrum, it can either be trimmed or repaired with sutures depending on the location of the tear and the quality of the tissue.

"Surgeons used to do open procedures to address hip impingement, but now there's really not much that we can't do arthroscopically," said Salvo, who estimates he performs about 200 hip preservation procedures a year.

Athletes under 30 take up a large percentage of Salvo's cases, while his second peak of patients is those in their 40s and 50s with impingement or labral tears that are often due to deterioration. Yet, hip replacements only last 15 to 20 years on average.

"Before hip preservation, your option was often to just try to deal with the symptoms because it wasn't bad enough for replacement," said Salvo.

Now, doctors are using the technology to clean up the pathology in the hip so that younger patients can try to prevent, or at least delay, hip arthritis and avoid having to get a second hip replacement later on in life.

"Will you eventually need a replacement? Yes," said Rick Cushman, manager of public relations at Rothman Institute. "But now we can get you to the point where you can remain active because you're young, and by the time you need a hip replacement, it will last you the rest of your life."

And with combined surgeries at Vincera, gone are the days of shuttling from doctor to doctor as you transition from surgery to rehabilitation. Many of their patients start rehab at the center the next day.

Plus, the success rates of both procedures paint a positive picture for patients.

In the 25 years Meyers has been performing core muscle injury repairs, he has reported a 95 to 96 percent success rate.

"We measure the success rate by the number of patients who can return to their previous performance level or above following the surgery," said Meyers. "Most of time, that four or five percent get better but they don't make a full return because other problems start to creep in."

Salvo reports an 85 to 90 percent success rate for hip preservation procedures.

"Ten percent will get better but still have some limitations, often strength deficits or problems with mechanics, while only about 5 percent can get worse and those cases are often hard to explain," said Salvo.

Read more Sports Doc for Sports Medicine and Fitness.