A crushed ankle and a damaged hip. That was the reality that Jonathan Hoehn,
22, faced one year ago this month after suffering a motorcycle accident
in San Diego. He was rushed to a local hospital where they immediately
performed surgery on him to repair the critical damage. The bones mended,
but the pain remained.
“The doctor told me that after six months, I should be well enough
to go back to work,” Hoehn said. “But my ankle and hip were
still killing me, still very painful.”
Hoehn still didn’t feel well enough to work, so he sought out a second
opinion and found his way to Dr. Harish Hosalkar, a highly respected orthopedic
surgeon who is affiliated with the San Diego Spine & Joint Center
at Paradise Valley Hospital. Dr. Hosalkar specializes in pediatric, adolescent
and adult hip preservation and reconstruction, deformity correction, limb
reconstruction, and orthopedic trauma.
After meeting with Hoehn, Dr. Hosalkar suspected a tear in the acetabular
labrum, the cartilage that seals and protects the ball-and-socket hip
joint. The labrum also acts as a shock absorber for the hip, which is
a major weight-bearing joint. If the labrum is damaged and torn following
injury, as in the case of Hoehn, this can cause severe pain, and even
more damage to the affected area over time. A subsequent scan performed
on Hoehn, a magnetic resonance arthrogram, confirmed Dr. Hosalkar’s
Dr. Hosalkar and Hoehn decided to first try non-surgical solutions, including
modified activities, anti-inflammatory medications, physical therapy and
a regimen of three platelet rich plasma (PRP) injections. PRP is the plasma
isolated from patient’s own blood enriched with a higher concentration
of platelets and other factors, which are known to play a role in tissue
healing. However, Hoehn’s traumatic labral tear proved too extensive
for these conservative approaches. He had suffered a three centimeter
tear in the anterio-superior labrum with detachment.
They decided that their only recourse would be hip-preservation surgery.
Because Hoehn’s ankle injury was on the same side as his injured
hip, Dr. Hosalkar felt he wouldn’t be able to perform traditional
pure arthrocopic hip surgery on a traction table, where sustained longitudinal
traction is applied on the leg to “sub-luxate” the hip (pull
the ball-joint out of the hip socket) for several hours.
Instead, Dr. Hosalkar used a “small incision”-lateral approach
with trochanteric-flip and arthroscopically assisted labral repair. With
this technique, there is no need to keep Hoehn in sustained traction.
Consequently, Hoehn was able to move his hip right after surgery on a
contained passive movement (CPM) rehabilitation machine while he was still
recovering in the hospital, and was able to start his physical therapy
regimen in less than a day.
His post-surgical pain was managed with a multimodal approach by Paradise
Valley Hospital’s pain management team, including the use of liposomal
bupivacaine, a long-lasting local anesthetic. This provided Hoehn with
excellent pain-management results.
Dr. Hosalkar successfully performed the surgery in March and, today, after
a few months of diligently following Dr. Hosalkar’s rehabilitation
regimen, Hoehn is satisfied with his outcome. “The rehab took longer
than I liked,” said Hoehn, “but it’s absolutely worth
it! I feel no pain or strain on my hip at all. Sometimes I forget that
my hip was injured in the first place!”
Hoehn credits Dr. Hosalkar and his hospital healthcare team. “Everyone,
from the doctors, staff and therapists were wonderful! I can’t say
enough good things about the Spine & Joint Center!”