What is hip preservation?

What is hip preservation? Journal of Hip Preservation Surgery Vol. 5, No. 2, pp. 103–104 doi: 10.1093/jhps/hny015 Editorial EDITORIAL What do we mean when we use the word ‘preservation’? reconstruct. Anatomy is removed, sometimes small, some- Are we conserving the whole joint, just the bone, perhaps times large, so that something further may be created. only the articular cartilage? Or, are we setting the scene for There are so many definitions when it comes to preserva- repair, or are we simply preserving function? Therein lies a tion. What appears without doubt is that conserving hip problem, I sense, as when it comes to preservation, each of function if far more multidisciplinary than we might have us means something different. One could say that preserva- originally thought. tion is synonymous with hip arthroscopy, but clearly it is So, from there arises my suggestion, an idea which I not. One could say that any surgery to the hip that does pray creates debate. Should this journal, our journal, not open its doors wider and encompass the full spectrum of not involve arthroplasty could be defined as a preservation manoeuvre. After all, the United Kingdom has something hip preservation? Assuming we agree that each of us sees called the Non-Arthroplasty Hip Register. And yet, surely preservation differently, why not encourage submissions even arthroplasty surgeons are preserving the hip in some from physicians, whose aim is to keep patients from us? way? Why not welcome our arthroplasty colleagues provided How about resurfacing, interposition, stubby stems, bi- they seek to preserve the hip in some way? Does it truly polar replacements, cementless joints and even hemiar- matter that a portion of metal is placed within a joint? It is throplasties? Are these not preserving portions of the hip what the practitioner has sought to preserve that counts, to some degree, in case something further is needed? Look not necessarily the way it has been achieved. at our forefathers, who undertook arthrodesis, osteotomy, My comments will be like a red flag to a bull for some, hanging hips and plenty more. In their way they were try- food for thought to others, but do send me your ideas ing to preserve natural tissue. Preservation as a concept, should you have the opportunity. As an editorial team we and as a technique, has been around for decades, probably manifestly have views but let us hear yours as well. Turning to the last issue of JHPS, again we were spoiled centuries in reality. We are not as new as we like to think. All surgeons preserve something when they operate, just for choice. The moment I feel I am up to speed with the look at the fixation of fractures. globe’s involvement in hip preservation, in comes a sub- Indeed, when it comes to preservation, must we physic- mission that makes me realize I am actually out of date. ally operate at all? After all, even the management of fem- Our last issue, number 5.1, had a fair few papers that oral neck osteoporosis is preserving the hip in its way. And encouraged any of us who may still not be repairing labra to believe me, in my humanitarian life, when as a surgeon I think again. There was the paper by Carton and Filon [1] am patching up war wounded, replacing the hip of a 25- on preserving the chondrolabral interface, that by Locks et year-old who has been shot through the pelvis, the femoral al. [2] on the outcomes after labral repair with capsule or head now being non-existent, is itself a form of rectus femoris, or that by Weidner, Wyatt and Beck [3]on preservation. labral augmentation with the ligamentum teres. Labral repair Way back, when this journal was first created, as Editor- is in, it seems that labral resection is out. in-Chief I received a letter from a surgeon asking if she Meanwhile this issue, issue 5.2, excites me enormously. might submit a paper on the late effects of resurfacing. At Have a look at the content once you have accessed the that time, I declined the suggestion. I had in my mind that issue and you will see how, perhaps for the first time, there any form of arthroplasty meant the hip was no longer pre- is much more to our content than just hip arthroscopic served. Yet look at us now, burring away cam lesions, tak- surgery. There is plenty on venous thromboembolism after ing down rims, removing, yes removing articular cartilage hip preservation surgery [4], be that open or arthroscopic and sometimes excising whole labra in order to [5]. I am relieved the authors concluded that the V C The Author(s) 2018. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/jhps/article-abstract/5/2/103/4996728 by Ed 'DeepDyve' Gillespie user on 20 June 2018 104  Editorial prevalence of venous thromboembolism after hip preserva- REFERENCES tion surgery is, as they describe it, ‘acceptably low’. There 1. Carton PF, Filan D. Labral cuff refixation in the hip: rationale and is plenty on other things, too. operative technique for preserving the chondrolabral interface for There is one metric, if that is the right description, that labral repair: a case series. J Hip Preserv Surg 2018; 5: 78–87. also excites me and that is our most frequently read paper. 2. Locks R, Chahla J, Bolia IK et al. Outcomes following arthroscopic hip segmental labral reconstruction using autologous capsule tissue It shows how the hip preservation community is thinking. or indirect head of the rectus tendon. J Hip Preserv Surg 2018; 5: First prize was for a long time held by John O’Donnell and 73–7. his unit’s excellent review of the ligamentum teres [6]. 3. Weidner J, Wyatt M, Beck M. Labral augmentation with ligamen- Now, step forward Hal Martin and his team whose 2015 tum capitis femoris: presentation of a new technique and prelimin- paper on the deep gluteal syndrome [7] has moved upward ary results. J Hip Preserv Surg 2018; 5: 47–53. to pole position. It is telling, too, that none of our top 4. Kraeutler MJ, Raju S, Garabekyan T, Mei-Dan O. Incidence of three papers has anything to do with femoroacetabular im- deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis. J Hip pingement. My how times have changed. Preserv Surg 2018; 5: 119–24. So, as ever, please enjoy this issue of JHPS. It is pub- 5. Azboy I, Kheir MM, Huang R, Parvizi J. Aspirin provides adequate lished for you, the hip preservation practitioner, and is VTE prophylaxis for patients undergoing hip preservation surgery, filled from cover to cover with brilliance. I commend this including periacetabular osteotomy. J Hip Preserv Surg 2018; 5: issue to you in its entirety. 125–30. My very best wishes to you all. 6. O’Donnell JM, Pritchard M, Salas AP, Singh PJ. The ligamentum teres - its increasing importance. J Hip Preserv Surg 2014; 1: 3–11. Richard (Ricky) Villar 7. Martin HD, Reddy M, Gomez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg 2015; 2: 99–107. Editor-in-Chief, Journal of Hip Preservation Surgery Downloaded from https://academic.oup.com/jhps/article-abstract/5/2/103/4996728 by Ed 'DeepDyve' Gillespie user on 20 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Hip Preservation Surgery Oxford University Press

What is hip preservation?

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Abstract

Journal of Hip Preservation Surgery Vol. 5, No. 2, pp. 103–104 doi: 10.1093/jhps/hny015 Editorial EDITORIAL What do we mean when we use the word ‘preservation’? reconstruct. Anatomy is removed, sometimes small, some- Are we conserving the whole joint, just the bone, perhaps times large, so that something further may be created. only the articular cartilage? Or, are we setting the scene for There are so many definitions when it comes to preserva- repair, or are we simply preserving function? Therein lies a tion. What appears without doubt is that conserving hip problem, I sense, as when it comes to preservation, each of function if far more multidisciplinary than we might have us means something different. One could say that preserva- originally thought. tion is synonymous with hip arthroscopy, but clearly it is So, from there arises my suggestion, an idea which I not. One could say that any surgery to the hip that does pray creates debate. Should this journal, our journal, not open its doors wider and encompass the full spectrum of not involve arthroplasty could be defined as a preservation manoeuvre. After all, the United Kingdom has something hip preservation? Assuming we agree that each of us sees called the Non-Arthroplasty Hip Register. And yet, surely preservation differently, why not encourage submissions even arthroplasty surgeons are preserving the hip in some from physicians, whose aim is to keep patients from us? way? Why not welcome our arthroplasty colleagues provided How about resurfacing, interposition, stubby stems, bi- they seek to preserve the hip in some way? Does it truly polar replacements, cementless joints and even hemiar- matter that a portion of metal is placed within a joint? It is throplasties? Are these not preserving portions of the hip what the practitioner has sought to preserve that counts, to some degree, in case something further is needed? Look not necessarily the way it has been achieved. at our forefathers, who undertook arthrodesis, osteotomy, My comments will be like a red flag to a bull for some, hanging hips and plenty more. In their way they were try- food for thought to others, but do send me your ideas ing to preserve natural tissue. Preservation as a concept, should you have the opportunity. As an editorial team we and as a technique, has been around for decades, probably manifestly have views but let us hear yours as well. Turning to the last issue of JHPS, again we were spoiled centuries in reality. We are not as new as we like to think. All surgeons preserve something when they operate, just for choice. The moment I feel I am up to speed with the look at the fixation of fractures. globe’s involvement in hip preservation, in comes a sub- Indeed, when it comes to preservation, must we physic- mission that makes me realize I am actually out of date. ally operate at all? After all, even the management of fem- Our last issue, number 5.1, had a fair few papers that oral neck osteoporosis is preserving the hip in its way. And encouraged any of us who may still not be repairing labra to believe me, in my humanitarian life, when as a surgeon I think again. There was the paper by Carton and Filon [1] am patching up war wounded, replacing the hip of a 25- on preserving the chondrolabral interface, that by Locks et year-old who has been shot through the pelvis, the femoral al. [2] on the outcomes after labral repair with capsule or head now being non-existent, is itself a form of rectus femoris, or that by Weidner, Wyatt and Beck [3]on preservation. labral augmentation with the ligamentum teres. Labral repair Way back, when this journal was first created, as Editor- is in, it seems that labral resection is out. in-Chief I received a letter from a surgeon asking if she Meanwhile this issue, issue 5.2, excites me enormously. might submit a paper on the late effects of resurfacing. At Have a look at the content once you have accessed the that time, I declined the suggestion. I had in my mind that issue and you will see how, perhaps for the first time, there any form of arthroplasty meant the hip was no longer pre- is much more to our content than just hip arthroscopic served. Yet look at us now, burring away cam lesions, tak- surgery. There is plenty on venous thromboembolism after ing down rims, removing, yes removing articular cartilage hip preservation surgery [4], be that open or arthroscopic and sometimes excising whole labra in order to [5]. I am relieved the authors concluded that the V C The Author(s) 2018. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/jhps/article-abstract/5/2/103/4996728 by Ed 'DeepDyve' Gillespie user on 20 June 2018 104  Editorial prevalence of venous thromboembolism after hip preserva- REFERENCES tion surgery is, as they describe it, ‘acceptably low’. There 1. Carton PF, Filan D. Labral cuff refixation in the hip: rationale and is plenty on other things, too. operative technique for preserving the chondrolabral interface for There is one metric, if that is the right description, that labral repair: a case series. J Hip Preserv Surg 2018; 5: 78–87. also excites me and that is our most frequently read paper. 2. Locks R, Chahla J, Bolia IK et al. Outcomes following arthroscopic hip segmental labral reconstruction using autologous capsule tissue It shows how the hip preservation community is thinking. or indirect head of the rectus tendon. J Hip Preserv Surg 2018; 5: First prize was for a long time held by John O’Donnell and 73–7. his unit’s excellent review of the ligamentum teres [6]. 3. Weidner J, Wyatt M, Beck M. Labral augmentation with ligamen- Now, step forward Hal Martin and his team whose 2015 tum capitis femoris: presentation of a new technique and prelimin- paper on the deep gluteal syndrome [7] has moved upward ary results. J Hip Preserv Surg 2018; 5: 47–53. to pole position. It is telling, too, that none of our top 4. Kraeutler MJ, Raju S, Garabekyan T, Mei-Dan O. Incidence of three papers has anything to do with femoroacetabular im- deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis. J Hip pingement. My how times have changed. Preserv Surg 2018; 5: 119–24. So, as ever, please enjoy this issue of JHPS. It is pub- 5. Azboy I, Kheir MM, Huang R, Parvizi J. Aspirin provides adequate lished for you, the hip preservation practitioner, and is VTE prophylaxis for patients undergoing hip preservation surgery, filled from cover to cover with brilliance. I commend this including periacetabular osteotomy. J Hip Preserv Surg 2018; 5: issue to you in its entirety. 125–30. My very best wishes to you all. 6. O’Donnell JM, Pritchard M, Salas AP, Singh PJ. The ligamentum teres - its increasing importance. J Hip Preserv Surg 2014; 1: 3–11. Richard (Ricky) Villar 7. Martin HD, Reddy M, Gomez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg 2015; 2: 99–107. Editor-in-Chief, Journal of Hip Preservation Surgery Downloaded from https://academic.oup.com/jhps/article-abstract/5/2/103/4996728 by Ed 'DeepDyve' Gillespie user on 20 June 2018

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Journal of Hip Preservation SurgeryOxford University Press

Published: May 16, 2018

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