Good morning, my name is Tom Wurtz and this is Guillaume Dumont, we both are running this and moderating this session. Thank you for coming here, it's a good turnout, I'm glad you found it, somewhere in the corner on the back of the conference. So we have a nice little room here, got a nice lineup of talks and I just want to get going I guess. The first speaker is Dr. Al Stubbs from Wake Forest, come up and we're going to run this session, then have a Q&A session, then the abstracts, another question and answer session. Thanks. Thank you Guillaume and Tom for the opportunity to be able to speak today. Very excited to be in New Orleans, hope you guys are enjoying the city, it's like the first time back maybe since Academy for a lot of us. Anyway, fun to be back and this is a great group of people here today so very happy you're here. Go ahead and get started. So my disclosures are through the Academy, they've been updated and I'll just say that if you're interested in hip preservation, I see a lot of our members here, but we'd love to have you join ISHA, Anna's a fantastic group, certainly for North America, but if you're interested in an international experience, we'd love to have you be part of our ISHA family. It's a great group, our meeting in Cape Town is in October, we're going to be in DC next year, so we'd love to have you guys join if you have an interest. This is a video I always enjoy, right approach, wrong outcome. So when you start thinking about patient optimization, this is a slide I use a lot, which is the thorn in lion's paw, which is a lot of what we see are very healthy patients who really are presenting with solely hip pain, right? I mean the average age we're seeing is 28 and if we can address this one small area, these patients, their quality of life very much improves and I think those in the hip preservation community very much understand this. There's four components to ensuring the best outcome, we're going to have some folks talk about radiology, but I'll talk a little bit about history, physical exam, and really meeting patient expectations because that's, I think, how you get the best outcomes. A fascinating study, this came out, was presented in 2014, but basically Phil Noble and his team looked at what do total hip patients, what are they looking for, and I think understanding expectations in our space makes a difference, right? And so when you look at males and females, classic genders, right, together, what are people looking for? The males want to be able to have sex, jog, and shop. Females typically want to shop, have sex, and garden, right? It's kind of interesting, right? How about the total hip population, walking, sex, and golf, walking, shopping, and sex? It's kind of interesting when you think about it, because if you're not actually meeting these expectations, then your outcomes really don't matter. So you need to anticipate, understand, and deliver, and there's a variety of literature articles that support this. Hip pain, I would define as chronic if it's gone on for more than three to six months. The location can be classically anterior, but you're going to find in the hip preservation space can be a lateral or posterior problem, and understanding a lot of other things. And really, there's typical hip pain and what we would call atypical, and I think the atypical hip pain is really what is the challenge for a lot of us. The longer duration of symptoms are correlated with worse acetabular chondromalacia, so the longer someone has pain, specifically in the male population, they're going to have more arthritis, and really, if you don't involve yourself early enough, their reported outcomes are worse. We've looked at this, Philippon and Vails looked at this, so how long can you really wait to intervene, and ultimately, what is the source, right? This is oftentimes what's very hard, an extra-articular problem. It's very interesting, because back in 2005, I had this slide, right, it's very simplistic, it's basically saying why is the cartilage tearing, why do we have chondrolabral problems, and really, when you think about the modern interpretation of this, it gets, it's not so much more complex, but there's a lot more things that have been going on, so as a hip preservationist, you need to be able to weigh a variety of problems and come together with a solution. Ultimately, 98% of the decision that one makes really comes down to taking the appropriate history and physical exam, and inter-articular is really, Tom Bird talks about the C sign, it's really an asymmetric motion loss, in my opinion. Inter-articular diagnoses oftentimes are a diagnosis of exclusion, right, and so these diagnostic injections, certain imaging modalities can oftentimes determine whether it's a simple sprain or strain, or whether you're dealing with an inter-articular issue. Hip instability has become a very interesting topic, and we may hear more about it today, but ultimately, what you're trying to figure out is, you know, is this something that is an atraumatic, what we call micro-instability, and certainly, you don't want to contribute to more of that, that's the iatrogenic side. Physical exam, you want to make sure that's standardized, and again, looking at symmetry of range of motion. When you start to lose symmetry, that should be a red flag that it is more of an inter-articular problem. This, interestingly, is a figure four test, right, I mean, when I was coming along, this was considered an SI joint pathology, right, when you saw this, but Mark Philippon really looked at this, and so we use this as a very sensitive test, right. The fundamentals to get superior outcomes are really to look at the basics of orthopedics, and that's why I think everyone is here today. What we're really looking at in the hip joint life cycle is what I would call phase two, right, that's really how do you repair, how do you reconstruct, what are you doing to encourage healing within the joint, right, because if you can't get it to heal, that's where arthroplasty becomes important. So the strategic approach is looking at things as a system and part of a kinetic chain. The surgical candidate decision really comes down to determining what is the right operation for your patient, and optimizing the patient experience really is identifying and meeting expectations, recommending and doing the correct operation. I usually recommend saying that you want to be able to offer at least five years, right. If you're going to intervene, you need to be able to say, I can get you securely five years of a good outcome, right. The post-op rehab MESA, we talk about getting motion established, endurance, then strengthening, then activity. If you try to reverse that, that's usually where patients run into problems, and we've gotten very good at not using narcotics in this patient population, right. So for the last five years, we do not routinely use narcotics in that postoperative space. We use a lot of antispasmodics. We use Galaxin, we use Valium, but trying to avoid a lot of the side effects that come with that. So our vision really is to identify the hip at risk. We're still looking at the genetic issues, the biomarkers that put someone at risk. Looking at the orthobiologic therapy, I will tell you that we're fortunate that now we're just on the cusp of getting to the heart of using orthobiologics for what we do. And then early correction of mechanical derangement, maybe, maybe we're able to change the natural history of what we see. So hip arthroscopy is ultimately best indicated for patients with hip pain that's gone on for at least three to six months. They're losing motion, losing strength, coordination, pain with provocative testing, and hopefully no evidence of significant radiographic arthritis. But we're all better lucky than good. So I appreciate everyone coming in today, and I look forward to hearing everyone else's talks. Thank you.

patient optimization

meeting patient expectations

hip pain

diagnosing atypical hip pain

post-operative rehabilitation