Richard N Villar MB BS BSc(Hons) MA MS FRCS, is a Consultant Orthopaedic surgeon who specialises in hip and knee conditions. Mr Villar works at Adenbrookes Hospital and The Cambridge Lea Hospital, Cambridge, UK. He has played a major role in the development of hip arthroscopy.
His world renowned expertise in this new technique has meant that Mr Villar attracts referrals and visitors to view the technique from far afield. He has published scores of research articles and presented at over 100 symposiums, in addition to writing the first world text on the subject of hip arthroscopy.
What inspired you to pioneer the technique of hip arthroscopy?
“I stumbled across hip arthroscopy purely by chance in 1988. I had at that stage undergone some basic training in Toronto, Canada, on the arthroscopy of many joints but not the hip. I made initial approaches to Dr Jim Glick at that time who encouraged me to try hip arthroscopy in the United Kingdom, although his own experience at that stage was still quite limited.
“My first case happened to be a patient with a loose body in the hip, something that was not visible on plain x-ray, and who achieved a full cure immediately after hip arthroscopic retrieval. I sometimes think that if it had not been for that first success, I would never have expanded the technique further!”
Could you briefly explain what developing this technique involved?
“Initially we undertook hip arthroscopy on a traction table, although I had no idea at the start how one could gain satisfactory access to the hip joint at all. The earlier papers had suggested it was impossible to gain arthroscopic access. Nevertheless, I was lucky, and in due course began to use a specialist hip distractor, which I then modified in my own way, leading to a technique that is in reality quite simple to do. However, I would say that at least the first 100 hip arthroscopies were extremely difficult and I always exclude this first 100 from any scientific papers I write.”
Hip arthroscopy has been particularly important in the diagnosis and management of acetabular labrum tears. This condition was not mentioned in the literature ten years ago. Soccer players are now increasingly being diagnosed with this problem. How do you think these people coped before the advent of hip arthroscopy?
“Your question about soccer players who are increasingly being diagnosed with the problem of labral pathology is an interesting one. Over the last few years I have had the honour to arthroscope the hips of many sportsman, not only footballers. I have to say that many of them do have labral pathology and a lot of them also have articular cartilage damage on the front of the acetabulum.
“Instinct tells me that many of these so called ‘groin strains’ are not groin strains at all but are actually labral or chondral defects within the hip. One obviously has to be very careful about arthroscoping a premier sportsmen as there is a clear morbidity following hip arthroscopy, of the order of 5%. It is not a technique for the occasional operator for this reason!”
What are the guidelines for rehabilitation following arthroscopic repair of an acetabular labrum tear?
“Since I began hip arthroscopy I have tended to advise patients that they should avoid unexpected twists and turns on the hip for up to three months after surgery. This is a rather empirical value and it is based on my experience of all cases, all age groups, all occupations, and all diagnoses. It is, I freely admit a gross generalisation. However, I tend to ask patients to keep their movements within the midline, certainly for a six week period. They can then gradually introduce rotational movements to the hip, but such movements must be under their own control. At the three month point, assuming all is well, I take the plunge and allow the patient back to unprotected, full activities.”
What other conditions is hip arthroscopy used for?
“Hip arthroscopy is obviously used for all manner of conditions, most of which are outlined on my web site. In fact, labral pathology is not the commonest reason for undertaking it. I would often use it for osteoarthritic debridement in the younger individual, assuming access is possible. Loose body retrieval is normally easily performed by hip arthroscopy, as is synovectomy, drilling of chondral defects, debridement for sepsis, excision of benign intra-articular tumours (for example a lipoma), assessment for osteoarthritic change, assessment of the hip prior to a possible pelvic osteotomy, debridement of the hip after a fracture-dislocation, a ruptured ligamentum teres, excision of a central osteophyte, and others.”