Spokane surgeons carve outpatient hip-arthroscopy niche

Two doctors at Spokane-based Northwest Orthopaedic Specialists PS are performing an outpatient hip-joint repair procedure, called hip arthroscopy, here on referral patients from throughout the Northwest.

The physicians, Dr. Patrick Lynch and Dr. Russell VanderWilde, perform the procedure at

Arthroscopy is a minimally invasive surgical procedure more commonly performed on knees and shoulders to assess and treat problems in those joints. Arthroscopic surgery is employed to treat torn and damaged cartilage and ligaments, to remove loose tissue, and to repair the surfaces of the joint area.

The procedure involves the use of a tiny camera on a probe that's inserted through a small incision to allow a surgeon to view and evaluate a joint without making large open incisions. Separate instruments that the surgeons select from an assortment of long probes, hooks, clamps, and suction devices also are inserted through tiny incisions to make repairs.

The hip-arthroscopy procedure requires the use of a traction device that partially separates the hip joint to make room there so surgeons can manipulate the various instruments they use in the surgery.

"For every 20 people who have had a knee scope, maybe only one has even heard of a hip scope," Lynch says.

Yet, he and VanderWilde have done hundreds of the hip arthroscopy procedures, including seven that Lynch performed in the last week of May, five of which he performed in one day.

The number of hip-arthroscopy procedures Lynch and VanderWilde perform has increased dramatically since they began doing them as an outpatient procedure at the Orthopaedic Surgery Center in September 2005, says Nancy Yohe, clinical director of the center.

In 2006, Lynch performed 158 of the procedures, all at the Orthopaedic Surgery Center, up from 77 hip arthroscopies the previous year, 29 of which were performed at the center. Before the Orthopaedic Surgery Center was set up for hip arthroscopy, the doctors performed the procedure in hospitals, Yohe says.

Lynch says not many surgeons are trained in hip-arthroscopy or wish to pursue the specialized procedure.

"It's technically demanding surgery," he says, referring in part to the need to open the joint with traction and to use unique implements, which are longer than those used for knee and shoulder joints.

Lynch began specializing in hips about 10 years ago. His partner, VanderWilde, has worked on hips longer than that, although he's even more well-known for his work with sports-related shoulder injuries, Lynch says.

Lynch says he spends about a third or more of his week working with hip issues.

"Other than major reconstruction or trauma, if a person comes to me with a hip problem, I can usually fix it," he says.

Patient referrals for hip arthroscopy come to Lynch and VanderWilde from throughout the Northwest, because there are so few doctors who perform the procedure, Lynch says.

Outside of the Spokane area, the nearest surgeons who perform hip arthroscopic procedures are in Seattle and Portland, he says.

Lynch says general practitioners are getting better at identifying hip problems before they send patients to him.

"The biggest problem at first was people would get sent to me for every kind of hip pain," Lynch says.

A high percentage of cases of hip-area pain doesn't involve joint problems, he says.

Sometimes, that pain is caused by back and pelvic problems, which are outside of Lynch's specialties.

Advances in diagnostic tests, such as magnetic resonance imaging, and greater awareness of sports- and other activityrelated injuries have led to improvements in evaluations of patients referred to him, Lynch says.

"I'm finding doctors are doing thorough evaluations and appropriate referrals," he says. "Now, when a patient comes to me with a hip pain, it's really the hip."

The typical candidate for hip arthroscopy is an active person in their 30s to 50s who has been slowed down by a sharp hip pain that's not caused by arthritis, he says. The pain is generally caused by injury and wear from activity, including loose or torn pieces of cartilage or ligaments that find their way into the joint.

"By the time they get to my office they might have had the pain for a long time," Lynch says.

Many patients who come to him have been dealing with pain for years, not realizing they have a problem that's treatable and that doesn't require hipreplacement surgery.

The outpatient hip arthroscopy at the Orthopaedic Surgery Center takes about 45 minutes in the operating room, during which the surgeons typically repair cartilage and ligaments and clean out joint surfaces, while the joint area is completely numbed by a local anesthetic.

The average patient time at the center is about two and a half hours from checkin to check-out, and patients usually are able to walk by the time they get home.

By contrast, open hip surgery would require a hospital stay and a far longer recovery time.

A hospital stay is also more expensive, says James Webster, Northwest Orthopaedic Specialists' chief financial officer. Outpatient procedures cost a third to a half of what hospital inpatient procedures cost, Webster says.

In some cases, hip arthroscopy can delay or eliminate the potential need for a hip replacement, he says. Lynch says he performs about five hip arthroscopies for every hip replacement and about 15 knee arthroscopies for every knee replacement.

"The vast majority of knee and hip problems in all age groups do not require anything as involved as a joint replacement," he says.

He performs about 70 percent of all of his surgical procedures on an outpatient basis, he says.

Northwest Orthopaedic Specialists occupies 60,000 square feet of space on three floors of the Spokane Integrated Medical Plaza.

Its Orthopaedic: Surgery Center takes up one floor, has eight pre-operation cubicles in one partitioned area, four operating rooms, and a 3,000-square-foot open recovery area.

Northwest Orthopaedic Specialists has a network of 24 physicians in four locations in the Spokane area who work in sub-specialty areas of orthopedics, including sports medicine, arthroscopic surgery, trauma and fracture care, foot and ankle care, and hand and spine surgery.