By: 7 May 2021
Whether or not an injury requires surgery is not always a cut and dry question

Derek Ochiai, MD, fAAOS is a board certified orthopaedic surgeon in Arlington, VA. He practices at the Nirschl Orthopaedic Clinic. He is fellowship trained in sports medicine and he is a frequent lecturer and instructor of hip arthroscopy for Arthroscopy Association of North America and ISHA-The Hip Preservation Society.  


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

DO:  I was initially trained as an arthroscopic sports medicine surgeon.  Early on in my career, I became fascinated by hip injuries and the arthroscopic treatment of hip injuries and labral tears.  Since then, I have devoted a majority of my practice to hip arthroscopy.  In addition, I teach and lecture other orthopaedic surgeons on hip arthroscopy techniques.

OPN: When someone sees you with an injury, what factors do you consider before determining the best course of action?

DO:  There are a lot of factors.  Of course, diagnosing the injury properly is of utmost importance.  Age and activity level are big factors.  Chronicity of the issue (how long has it been going on for?) is another.  What type of treatments have already been tried?

OPN: Do you consider the long-term ramifications of delaying surgery over the short-term circumstances?

DO:  This is something I think about always.  Most people with the issues I treat will not have something dire happen if they delay surgery.  However, there is more research coming out that delaying surgery for hip labral tears and femoroacetabular impingement syndrome (FAIS) leads to poorer long-term outcomes.

OPN: Does the type of injury and age of patient influence your decisions?

DO:  Absolutely.  Sometimes patients come in with an acute (recent) injury that can be treated non-surgically, and it is always my preference to treat a patient without surgery (if that is reasonable).  Younger patients tend to have more isolated injuries, which can do better with either non-surgical or surgical treatment.  The older patients are, the more likely they are to also have joint degeneration (early onset arthritis), which makes the results of both non-surgical or surgical management less predictable.

OPN: Will the repercussions on healthcare due to the global pandemic this past year impact any decisions you may make?

DO:  Fortunately, all of my staff and more and more of my patients are being vaccinated, which helps make surgical decision-making closer (but not quite the same) as pre-pandemic.  Currently, no matter vaccination status, we are still requiring a negative covid-19 test prior to surgery, and still taking precautions with limiting family members in the pre-op and post-op surgery areas.  That being said, surgery is still a risk I take very seriously with every patient.

OPN: Are you currently involved in any research within your work?

DO:  I am currently doing a long-term research project on patient factors that influence the success of arthroscopic surgery.  I am also been passionate about developing products that make hip arthroscopy easier and more effective for all surgeons.

OPN: How can you improve a patient’s journey to a successful recovery?

DO:  If surgery has been offered, I think it is wise for the patient to do an internet search and learn about the procedure and the perspectives of others who have had the type of surgery offered.  Write down any questions or concerns.  THEN, make another appointment with your surgeon, and review all the questions and concerns (bring the list).  Better communication and education always leads to better patient experiences.

OPN: What does the future look like in the field of orthopaedic surgery and recovery?

DO:  Looking into the future, more and more surgeries will be truly “outpatient”, where the patient can go home the same day.  This is being accomplished already with less invasive, but effective, surgical procedures, better anaesthesia, optimising home health resources, and appropriately aggressive physical therapy.  The use of orthobiologics (platelet rich plasma, bone marrow aspirate, and others) may decrease the need for surgery altogether, leading to a faster overall recovery.  The key is methodical, unbiased research to give us the answers.