By: 8 July 2019
Surgeon in focus – Derek Ochiai

Derek Ochiai, a leading arthroscopic hip surgeon and sports medicine expert from the USA, discusses how the increase in hip injuries in younger people is related to sports injuries.

Derek Ochiai went to college at Cornell University, followed by medical school at Case Western Reserve University School of Medicine. He completed his orthopaedic residency at Albany Medical Center, before undertaking a sports medicine fellowship at the Nirschl/Georgetown Sports Medicine fellowship. He was then accepted on to the Arthroscopy Association of North America (AANA) Travelling Fellowship in 2006. He currently works in private practice at the Nirschl Orthopaedic Center, in Virginia, USA.  He works with athletes, from elite to weekend warriors, primarily focusing on hip issues and injuries.

Three-time major tennis champion Andy Murray has been troubled with hip pain for the past ten years. He underwent surgery earlier this year to alleviate the pain and is now considering another operation. He has spoken about retiring to help prevent the pain he has from his hip joint. Murray suffers from a type of joint disease that is typical of older people, but there is an increase in hip injuries in younger people related to sports injuries. Derek Ochiai discusses his thoughts with OPN.

OPN: As a specialist in orthopaedic surgery, could you tell us more about your experience and training background in this field?

DO: While I was doing my sports medicine fellowship in 2002, I had the opportunity to attend a hip arthroscopy course through the Arthroscopy Association of North America (AANA), which gave me a good initial exposure to hip arthroscopy.  Since 2006, I have been an instructor at AANA’s Master’s Experience in Hip Arthroscopy courses yearly.  I am frequently a lecturer and moderator at ISHA, The Hip Preservation Society.  I have also taught countless industry-sponsored hip cadaveric teaching labs.

Because of adaptation of Professor Ganz’s treatment of Femoroacetabular impingement (FAI) to an arthroscopic approach, the indications and potential for treating hip conditions with hip arthroscopy has expanded greatly, and hip arthroscopy is now about 90 per cent of my surgical practice.

OPN: Tell us more about your work and research in arthroscopic hip surgery?

DO: Through AANA, ISHA, and industry-sponsored courses, I have taught surgeons from around the globe hip arthroscopy techniques. My research in hip arthroscopy has, up until now, centred on technical aspects of the procedure (learning curve, exposure to radiation, portal placement, etc).  My current research focus is on patient-specific characteristics that can affect outcomes following hip arthroscopy.  In addition, I am involved with the development of new arthroscopy tools to allow surgeons to perform hip arthroscopy more easily and reproducibly.

OPN: Following the high profile story of tennis champion Andy Murray undergoing hip surgery, have you found there is an overall increase in younger people being affected by hip injury related to sports?

DO: Public awareness of hip conditions causing hip pain in young patients has risen over the past 10 years. Several high profile athletes have had hip conditions requiring hip arthroscopy and Andy Murray is the latest in a long line of high level athletes and entertainers who have required this procedure. The increased public awareness of hip labral tears and FAI is certainly, in part, a result of the publicity surrounding these patients.

OPN: What could be the long-term issues related to this?

DO: First, increased public awareness is a positive. Many patients who have chronic hip pain (but no arthritis on x-rays) have in the past been told that they have “chronic hip flexor tendonitis” or “pre-arthritis”.  Despite physical therapy treatment, many of these patients had continued to suffer with hip pain. With increased awareness of non-arthritic causes of hip pain, these patients are now seeking treatment that they may not have known about, without this awareness.

The potential negative is the chance of abuse of hip arthroscopy. Not every patient who has FAI on x-ray or a labral tear on MRI requires surgery. Just because there is now expertise and technology allowing hip arthroscopy does not mean that that specific patient would benefit from the procedure. In addition, with increased patient demand for hip arthroscopy, more surgeons are performing hip arthroscopy. My practice is now about 20 per cent second opinion revision hip arthroscopy, where an initial hip arthroscopy failed to achieve the desired result.

The long-term issue of labral tears and FAI are a statistically increased risk of hip arthritis at an earlier age than would be expected by actuarial tables. This does not mean that a specific patient will get arthritis in his/her hip early in life, it just means that it is more likely to happen.

OPN: Is there anything that can be done to prevent it?

DO: For prevention of labral tears and FAI, there is nothing reasonable to do at this time. There may be a correlation between extensive sports exposure in pre-teen years and FAI. Optimising core/gluteal strength can help to alleviate symptoms of FAI in some people. There is a recent peer reviewed article that suggests that if a patient is having hip pain symptoms because of labral tears and FAI, then the surgical outcomes of hip arthroscopy are better if the surgery is performed within two years of symptoms.

OPN: What is the recovery and success rate like for surgery in the younger patients?

DO:  Several studies have shown that the success rate (as defined by improvement in patient reported outcomes and return to sport) are very high in younger patients. A study conducted at Rush University in 2018 and featured in Arthroscopy showed 100 per cent return to swimming following hip arthroscopy, with 54 per cent returning at a higher level than before they even started having hip pain. Another study by Marc Philippon showed excellent return to play and improvement in pain in professional hockey players with hip labral tears and FAI, after hip arthroscopy. A study led by Thomas Byrd and published in American Journal of Sports Medicine showed 86 per cent return to sport in adolescents following hip arthroscopy.

In general, following an uncomplicated hip arthroscopy (labral repair and FAI osteoplasty), typical return to sport is in about four months.  If a patient has some articular cartilage damage requiring treatment (like microfracture), the recovery can be six months or longer to return to sport.  Ballet dancers with uncomplicated hip arthroscopy procedures typically take five to six months to return to performance ballet, since ballet is the most hip intensive sport that I typically treat.

OPN: What is the next step in your research and studies, how does the future look?

DO: My major focus is helping to improve outcomes for all hip arthroscopy patients. I’m trying to do this through teaching and education of surgeons; through clinical research in identifying factors that are related to patients’ outcomes, through product development to make hip arthroscopy safer, easier and more effective; and even through my Twitter (@DrDerekOchiai), to improve patient education and awareness of hip conditions and hip arthroscopy.