MBBS, FRACS (Orth)

Orthopaedic Surgeon

Mr Andrew Chia is a highly trained and qualified Orthopaedic Surgeon

with particular expertise in hip and knee surgery. He was appointed as
Consultant Orthopaedic Surgeon to three major public hospitals in 2010
including the Alfred Hospital where he gained experience in complex
Who Needs a THR?
Anterior approach
reconstructions. Dedicated to patient care, he utilises the latest
arthroscopic and minimally invasive techniques for the management of
all hip and knee conditions; thereby facilitating the best recovery and
outcome for patients from surgery.
• End stage osteoarthritis

Hip Replacement
Mr Andrew Chia has particular expertise in:
· Hip Arthroscopy
for the therapeutic management of femoral-acetabular impingement (FAI),
• Primary

•
labral and ligamentum teres tears, and other intra and extra-articular pathologies
· Anterior Minimally Invasive Hip Replacements Secondary
· Primary and Revision Hip and Knee Replacements
· Knee Arthroscopy and Arthroscopic Knee Ligament Reconstructions
• Inflammatory (Rheumatoid, sero-negative)
Mr Andrew Chia
Professional Associations:
· Royal Australasia College of Surgeons (RACS)
· Australian Orthopaedic Association (AOA) • Developmental (Dysplasia, Perthes, SUFE)
MBBS, FRACS (Orth), FAOrthA
Education and training:
· MBBS, University of Melbourne, 2000 • Trauma, AVN, infection
Orthopaedic Surgeon
· FRACS (Orth), RACS and AOA (Victoria), 2009

•
· Hip Arthroscopy Fellowship, Melbourne, Australia, 2011
· Hip and Knee Fellowship, Lyon, France, 2011 Femoral acetabular impingement, Labral tears
Consulting Rooms:
• 5 Studley Ave, Kew 3101
Hospital Appointments:
• Epworth, Richmond
• Pain, stiffness, poor function, poor gait, poor quality of life
• 21 Erin St, Richmond 3121 • Mercy Private, East
Ph. 03 9017 1119
Fax. 03 9017 1129
Melbourne
• VIMY House Private, Kew
• Failure of non-operative management
Mob. 0401 135 307
Email. mr.andrewchia@gmail.com • “Old” vs “Young and Active”

1 2

Aims for THR

• Pain relief
• Improve function and QOL
• Improve gait
• Restore ‘hip mechanics’
• Leg Length
• Offset
• Center of rotation
• Stability

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 Ideal Hip Approach Incision length?

• Inter-nervous plane ! • mini-incision VS mini-invasive

• Inter-muscular plane ! • Soft tissue preservation VS Cosmesis

• Minimise
• Soft tissue damage
• Blood loss
• Instability
• Hospital stay
• Maximise
• Pain relief
• Recovery
• Mobility

5 6

Common Hip Lateral Approach

Approaches

• Lateral (Hardinge) Approach

• Posterior (Southern) Approach

• Anterior (Smith-Peterson / Hueter)

Approach

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 Posterior Approach Anterior Approach
sartorius
iliopsoas
Femoral
  

 Nerve
rectus
  

femoris
tensor
  

fascia
  

latae
gluteus
  

minimus

gluteus
  

medius

gluteus
  

maximus

Superior
  

Gluteal
  

Nerve

9 10

MRI Result Anterior THR Results

• Rapid Rehabilitation and recovery with minimally invasive total hip arthroplasty; RA
Berger et al; Clin Orthop Relat Res, 2004, (429): 239-247

• Mini-incision anterior approach does not increase dislocation rate: a study of 1037
total hip Replacement; T Siguier et al; Clin Orthop Relat Res, 2004 Sep, (426): 164-73

• Cost benefit analysis of MIS THA: Model-based analysis of the consequences for
Switzerland; D Straumann et al; Hip International, Vol 16 no 2 (suppl 4), 2006 pp S54-
S57

• Minimally Invasive total hip arthroplasty: anterior approach; F Rachbauer; Orthopäde,

2006 Jul;35(7):723-4, 726-9
Muscle degeneration No muscle degeneration • Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior
approach; RM Meneghini et al, Clin Orthop Relat Res. 2006 Dec;453:293-8

1 year post-operative MRI study

• A Clinical Comparative Study of the Direct Anterior With Mini-Posterior Approach; K
Nakata et al; J Arthroplasty. 2008 Jun 12
Dr Dora & Dr Kalberer, University of Balgrist, Zurich, CH

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 What are the Risks? Contraindications to
Anterior THR?
• General risks

• Surgical: Infection, Blood loss (requiring

• NO absolute contraindication
transfusion), DVT, PE, Neuro-vascular injury • Few relative contraindications (related to
learning curve)
• Non Surgical: Anaesthetic, General medical

• Specific risks
• Abnormal anatomy (Hip dysplasia, Perthes,
Protrusio, Short varus femoral necks)
• Leg length, Dislocations, Fracture,
• Abnormal size (big / muscular patients)
Loosening, Wear
• Pre-existing Abductor tears

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Case Study #1

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6 weeks postop Case Study #2

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Case Study #2 Case Study #3

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 Bilateral AVN

RIGHT (symptomatic) LEFT (asymptomatic)

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Anterior Minimally
Invasive THR
• Ideal approach for THR
• The only TRUE minimal incision AND
minimally invasive approach
• Better outcome for patients
• Meets aims of THR
• Needs training and fellowship

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 MBBS, FRACS (Orth)
Orthopaedic Surgeon

Mr Andrew Chia is a highly trained and qualified Orthopaedic Surgeon

with particular expertise in hip and knee surgery. He was appointed as
Consultant Orthopaedic Surgeon to three major public hospitals in 2010

Questions? including the Alfred Hospital where he gained experience in complex

Hip Arthroscopy
reconstructions. Dedicated to patient care, he utilises the latest
arthroscopic and minimally invasive techniques for the management of
all hip and knee conditions; thereby facilitating the best recovery and
outcome for patients from surgery.

Hip Preservation
Mr Andrew Chia has particular expertise in:
· Hip Arthroscopy
for the therapeutic management of femoral-acetabular impingement (FAI),
labral and ligamentum teres tears, and other intra and extra-articular pathologies
· Anterior Minimally Invasive Hip Replacements
· Primary and Revision Hip and Knee Replacements
· Knee Arthroscopy and Arthroscopic Knee Ligament Reconstructions

Mr Andrew Chia
Professional Associations:
· Royal Australasia College of Surgeons (RACS)
· Australian Orthopaedic Association (AOA)

MBBS, FRACS (Orth), FAOrthA

Education and training:
· MBBS, University of Melbourne, 2000

Orthopaedic Surgeon
· FRACS (Orth), RACS and AOA (Victoria), 2009
· Hip Arthroscopy Fellowship, Melbourne, Australia, 2011
· Hip and Knee Fellowship, Lyon, France, 2011

Consulting Rooms: Hospital Appointments:

• 5 Studley Ave, Kew 3101 • Epworth, Richmond
• 21 Erin St, Richmond 3121 • Mercy Private, East
Ph. 03 9017 1119 Melbourne
Fax. 03 9017 1129 • VIMY House Private, Kew
Mob. 0401 135 307
Email. mr.andrewchia@gmail.com

25 26

What is hip arthroscopy? Why do hip arthroscopy?

• Minimally invasive surgical procedure
(keyhole) to treat pathologies in the hip
• Specially designed instruments and traction
table to access hip joint
• Technically very demanding
• Fellowship trained
• Thorough visualisation of intra and
extra-articular structures
• NO accurate or reliable Radiologic Test
exists for the diagnosis of hip
pathology
• Least intrusive means of diagnosis AND
treatment

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Femoral Acetabular Femoral Acetabular
Impingement (FAI) Impingement (FAI)

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Femoral Acetabular Management of FAI

Impingement (FAI)
• Non Operative
• Avoidance of activity, change sports
• Analgesics, NSAIDS, diagnostic injections
• Physiotherapy, massage, osteopathy,
chiropractic treatment etc.

• Operative - Hip Arthroscopy

• Early referral essential

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 Open Dislocation .. No!
Intra articular conditions
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What Conditions Does
Hip Arthroscopy Treat?
Extra articular conditions
• External snapping hip (ITB)
• Trochanteric bursitis
• Gluteus medius tendinopathy or tears
• Psoas tendinopahy
• etc
35
What Conditions Does
Hip Arthroscopy Treat?
• Femoral acetabular impingement (FAI)
• Cam lesion and pincer lesion
• Labral tears
• Chondral pathology, loose bodies, early OA
• Ligamentum teres tears
• Synovial pathology: Synovitis, Chondromatosis,
biopsy etc.
34
What are the Risks?
• General risks
• Surgical: Infection, DVT, PE
• Non Surgical: Anaesthetic, General medical
• Specific risks (<5%)
• Traction: Perineal, Nerve compression, Foot
• Fracture, Dislocation, AVN, HO
• Instrument failure, fluid extravasation
36
Contraindications to Hip Bilateral FAI, cam lesion
Arthroscopy?
• Advanced degenerative arthritis (< 2mm)

• High degree of acetabular retroversion

• Protrusio acetabuli

• Severe hip dysplasia

• Ankylosis of the hip

• Severe obesity (relative)

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RIGHT Lateral RIGHT Dunn view LEFT Lateral LEFT Dunn view

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Hip Arthroscopy: cam resection Hip Arthroscopy: cam resection

41 42

Bilateral FAI, Labral tear Hip Arthroscopy: labral repair

Labral repair
Labral tear
Anchors
Acetabular rim

RIGHT (asymptomatic) LEFT (symptomatic) LEFT (symptomatic)

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Hip Arthroscopy: lig Teres Hip Arthroscopy: labral repair

LT tear
stabilised Labral repair

Ligamentum teres tear

Ligamentum Teres
tear
Labral tear

LEFT (symptomatic) RIGHT (asymptomatic)

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Arthroscopic micro# Trochanteric Bursitis

• Lateral hip pain syndrome, Greater trochanteric
pain syndrome
• Long distance runners, cyclists, middle age women
• Incidence 4%-17% following THR (depending on
approach used, lateral offset, leg length)
• Most respond to non-operative measures:
• rest, ITB stretches, pelvic stability exercises
• injections: LA/ CS, autologous blood, PRP,
tenocytes, platelets
• Operative bursectomy for refractory cases

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 Arthroscopic Bursectomy Abductor repair

49 50

Arthroscopic Psoas Tenotomy Synovial chondromatosis

• Indications:
• Recalcitrant Psoas tendinopathy
• Psoas impingement (THR)
• Painful internal snapping hip
• (Psoas is 60% tendon, 40% muscle at this level)

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 Hip trauma

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Summary When to refer?

• FAI is a REAL problem especially in athletes
and active patients • URGENT referral if
• Hip arthroscopy is • Very young patient (<18 years old)

• A minimally invasive technique • Refer EARLY if

• SAFE and EFFECTIVE • Young patient (<50 years of age)

• Essential in DIAGNOSIS and TREATMENT of

• Potential for hip preservation surgery
many hip conditions • Acute traumatic hip injury

• Excellent short and medium term results • Continuing pain after 3 months of non-op Mx
• Guarded prognosis in the presence of arthritis • If X-Ray normal, consider MRI / CT before referral

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 MBBS, FRACS (Orth)
Orthopaedic Surgeon

Mr Andrew Chia is a highly trained and qualified Orthopaedic Surgeon

with particular expertise in hip and knee surgery. He was appointed as
Consultant Orthopaedic Surgeon to three major public hospitals in 2010

Questions? Thank You

including the Alfred Hospital where he gained experience in complex
reconstructions. Dedicated to patient care, he utilises the latest
arthroscopic and minimally invasive techniques for the management of
all hip and knee conditions; thereby facilitating the best recovery and
outcome for patients from surgery.
Mr Andrew Chia has particular expertise in:
· Hip Arthroscopy

Mr Andrew Chia
·
·
for the therapeutic management of femoral-acetabular impingement (FAI),
labral and ligamentum teres tears, and other intra and extra-articular pathologies
Anterior Minimally Invasive Hip Replacements
Primary and Revision Hip and Knee Replacements
MBBS, FRACS (Orth), FAOrthA
· Knee Arthroscopy and Arthroscopic Knee Ligament Reconstructions

Mr Andrew
Orthopaedic Chia
Professional Associations:
Surgeon
· Royal Australasia College of Surgeons (RACS)
· Australian Orthopaedic Association (AOA)

MBBS, FRACS (Orth),

!
Education and training: FAOrthA
· MBBS, University of Melbourne, 2000
Orthopaedic
Ph 03 9851 Surgeon
8555
· FRACS (Orth), RACS and AOA (Victoria), 2009
· Hip Arthroscopy Fellowship, Melbourne, Australia, 2011
· Hip and Knee Fellowship, Lyon, France, 2011
Fax 03 9851 8556
Consulting Rooms: Hospital Appointments:
• 5 Studley Ave, Kew 3101 !
• Epworth, Richmond
• Mercy Private, East
Email admin@arthrohealth.com.au
• 21 Erin St, Richmond 3121
Ph. 03 9017 1119 Melbourne
Fax. 03 9017 1129 • VIMY House Private, Kew
Mob. 0401 135 307 !
Email. mr.andrewchia@gmail.com
Web www.arthrohealth.com.au

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