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Speaker recalls 'phases' of hip arthroscopy
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ISTANBUL — Richard N. Villar, MD, divided the evolution of hip arthroscopy into four phases based on his own experiences as a hip arthroscopist during a presentation at the 14th EFORT Congress.
“Traditionally, I think the history of hip arthroscopy parallels that of endoscopy, and it is a matter of getting light into the joint cavity,” Villar, from Spine Cambridge Lea Hospital in Cambridge, United Kingdom, said. “The first light source with a Lichtleiter was a candle. This caused a certain number of injuries in patients. The second light source was a rag soaked in petrol that you lit, you had a brief lighter explosion and you could make a diagnosis before the light faded away.”
Richard N. Villar
Villar credits Thomas Edison, the inventor of the light bulb, as contributing significantly to surgical arthroscopy. Col. Eugen Bircher, MD, performed 60 knee arthroscopies in the 1920s using nitrogen and oxygen to light up the structures of the body before deciding that arthroscopy was not useful.
Michael S. Burman, MD, is generally credited as the first hip arthroscopist. However, Burman also had his reservations about the procedure, Villar said.
“He drew a picture in the Journal of Bone & Joint Surgery and he said the view was so bad that it was not worth doing,” Villar said. “But actually, he was the first man to draw an impingement lesion – he simply didn’t recognize what he was seeing.”
In his own life, Villar said he divides the evolution of hip arthroscopy into four phases. In the first phase, before 1990, knee arthroscopy instruments were used for hip procedures and the lateral approach was generally used.
The second phase between 1990 and 2000 was a “consolidation” period where Villar said the supine position developed and hip arthroscopies were performed for diagnostic purposes.
“If I look at my own practice, you can see how it is changed,” he said. “In 1990, 40% of what I was doing was diagnostic. Here, after 2010, [it is] less than 1 in 50.”
The third phase, between 2000 and 2010, saw an expansion of hip arthroscopy.
“Here, perhaps the most significant finding was the description of the peripheral compartment by Michael Dienst,” Villar said. “We now know the hip has two parts: a central and a peripheral compartment.”
Acetabular impingement was also rediscovered during this period.
“This opened the floodgates to hip arthroscopy,” he said. “Some centers demonstrated why the indications worked for the procedure. Papers now reported not [only] how to do it, but outcomes and results were also beginning to appear in literature.”
Today, Villar said orthopaedics is in the “diversification” phase where periarticular surgery is most significant. The field expanded with developments in iliotibial band surgery, sciatic neurolysis and ischiofemoral impingement.
Villar said he expects to see more future developments in hip impingement, instability and treating chondral damage.
Reference:
Villar RN. The evolution of hip arthroscopy. Presented at: 14th EFORT Congress. 5-8 June, 2013; Istanbul.
Disclosure: Villar is a consultant for Smith & Nephew.