Tigran Garabekyan, M.D., Author at Southern California Hip Institute

1658 West Avenue J
Lancaster, CA 93534
Tel: 661-942-6577

Location | Southern California Hip Institute | North Hollywood | Glendale Burbank | Encino | Sherman Oaks | Van Nuys

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Femoroacetabular impingement (FAI) presents one of the most common causes of hip pain in adolescent athletes. With this condition, movement of the hip joint is restricted due to abnormal bony contact between the ball (femur) and socket (acetabulum). FAI can be caused by a developmental abnormality of the ball or by an abnormally oriented or excessively deep socket, causing a painful restriction of motion. Left untreated, FAI can cause labrum tears, damage to surface cartilage, and early arthritis. Treatment is aimed at restoring the normal anatomy and improving the clearance for hip mobility through hip arthroscopy.

Given that many patients who have FAI suffer from the problem in both hips, this study investigates the safety and efficacy of performing bilateral hip arthroscopy in the same setting. The benefits are immense and include consolidating the overall recovery time with faster return to sport when compared with staged surgery. We were able to show that the bilateral procedure can be carried out safely and effectively with similar pain scores and time to return to sport when compared with unilateral surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us. Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles area.

Dr. Tigran Garabekyan was recently featured in VoyageLA’s “Mid-Wilshire Inspiration.” The article includes a full profile on Dr. Garabekyan and highlights his expertise in orthopedic surgery. Read the full article here.

Have you ever wondered how ballet dancers are able to move their hips through seemingly impossible arcs of motion, all while supporting their body weight and twisting, pivoting, or lunging several feet up in the air? Well the answer has a large part to do with the shape of their hips, and they’re quite literally born with it.

Female ballet dancers typically have loose ligaments and shallow hip sockets (dysplasia) that enable upwards of 160 degrees of flexion when most other hips are limited to 120 degrees before impingement occurs between the ball and socket (hip impingement). But, there’s a catch – the shallow hip socket relies much more on the labrum and surrounding soft tissue structures for stability and as a result, ballet dancers frequently suffer from labral tears, hip flexor tendonitis, and cartilage damage.

The key to maintaining healthy hips in dancers is to take enough time off between practice sessions and production performances to allow these “overuse” injuries to recover. Otherwise, the injuries can accumulate and eventually require treatment (PRP injections, hip arthroscopy, periacetabular osteotomy). Additionally, maintaining strength in the hip abductors, core, and paraspinal muscles serves to offload undue stress on the hip joints.

Hip dysplasia is a double-edged sword for dancers, simultaneously permitting extraordinary performance while predisposing to injury. By being diligent with foundational stretching/strengthening exercises and ensuring adequate time for recuperation, dancers can still enjoy a long and healthy career doing what they love most.

Read the full article here.

The Birmingham Interlocking Pelvic Osteotomy (BIPO) is a less well-known technique for correcting hip instability due to dysplasia. This technique uses an interlocking step cut in the ilium bone to create a stable construct and enable early weight-bearing, with a faster rehabilitation (Figure 1A and 1B). The procedure is carried out through two small incisions and this study shows overall survivorship of 76% at 10 years follow-up, with patients who were younger than 20 years of age enjoying 95% survivorship at 17 years follow-up!

Figure 1A 682x1024 - The Birmingham Interlocking Pelvic Osteotomy for Acetabular Dysplasia: 13- to 21- year Survival Outcomes

Figure 1B 300x165 - The Birmingham Interlocking Pelvic Osteotomy for Acetabular Dysplasia: 13- to 21- year Survival Outcomes

At SCHI we are actively studying the latest advances in surgical techniques to maximize healing and reduce recovery time in the treatment of hip dysplasia. Our goal is to provide the least invasive treatment option to get rid of your pain and get you back to the active lifestyle that you enjoy!

Read the full article here.

Various disorders of the hip and pelvis are amenable to conservative treatment with the use of platelet-rich-plasma (PRP). In this recent review article, we present the literature in support of using PRP to augment healing following surgical and conservative treatment of hip and pelvic disorders.

At SCHI we are actively studying the latest advances in biologic treatment options to maximize healing. Our goal is to provide the least invasive treatment option to get rid of your pain and get you back to the active lifestyle that you enjoy! unnamed 1 300x200 - The Use of Platelet-Rich-Plasma (PRP) To Augment Conservative and Surgical Treatment of Hip and Pelvic Disorders

Tigran Garabekyan M.D. – Your Los Angeles Area Hip Specialist

When an older patient (age > 65 years old) falls and sustains a displaced hip fracture (displaced = the fracture is shifted out of alignment), treatment typically consists of surgery to replace the hip joint (partial or total hip replacement). The implant is strong enough to withstand immediate, unrestricted weight bearing which is a great advantage as many older patients also suffer from early dementia or balance problems making it difficult for them to comply with protected weight bearing. Patients work with a physical therapist to get up from bed and walk immediately following surgery – reducing their risk of pneumonia, skin ulcers, and other complications from prolonged recumbency.

The treatment of a displaced hip fracture in younger patients (age < 65 years old) is a bit more complicated. These patients are typically healthier, more active, and have at least 25 more years of life to live. All of these factors jeopardize the longevity of a hip replacement implant and, therefore, every effort is made to preserve the native hip joint (hip preservation surgery). Partially displaced fractures are treated by surgically realigning the fragments and stabilizing with a plate-and-screw device to promote bony healing – as shown in the image below:

Completely displaced fractures, however, have a poor capacity for healing due to a disruption in the blood supply to the femoral head (the ball in the ball-and-socket hip joint). This means that even if the fracture is perfectly realigned and fixed, bony healing would likely not take place and ultimately the patient would have persistent pain requiring additional treatment. These fractures are treated with total hip replacement, and patients are cautioned to refrain from high impact activities (i.e. running, basketball, skiing) that may decrease the longevity of their implant and potentially require revision surgery to replace worn out parts.

The image above depicts a left hip fracture in a 50 year-old healthy and active female. The fracture occurred from a fall and caused displacement of the femoral head (ball) from the rest of the femur – as seen in the middle and right insets outlining the loss of normal contour of the upper femur. As a result of the displacement, the left leg is also shorter than the right. Given the degree of displaced, a long discussion was held with the patient regarding the concern for poor bony healing with attempted fixation. Ultimately, the patient elected to proceed with a total hip replacement, as she did not engage in any high impact activities and enjoyed hiking and dancing.

Total hip replacement was performed with a minimally invasive posterolateral approach using a ceramic ball, plastic (polyethylene) liner, and titanium cup and stem for improved longevity. The leg lengths are now even and the patient can enjoy rapid recovery and return to function.

Read the full article here.
Click here to open Arthroscopic Bone Grafting video.

Bone cysts in the hip occur most commonly in the setting of femoroacetabular impingement (FAI), hip instability (dysplasia), and arthritis. In addition to treating the underlying problem, decompression and bone grafting of the cyst can help alleviate pain and prevent further erosion of the fluid into the adjacent healthy bone. Historically, this has been accomplished by indirect means, using additional incisions and surgical dissection to gain access to the space behind the cyst for drilling and bone grafting.

Recently, we developed and published a technique to decompress and bone graft cysts in the hip socket directly through the central aspect of the hip using hip arthroscopy.

The bone cyst seen in the above image is located centrally within the hip socket due to hip instability from excessive femoral antetorsion. The rotational malalignment of the femur bone contributes to excessive “play” in the hip resulting in shear forces on the surface cartilage. With continued instability, the cartilage becomes delaminated from the underlying bone and allows fluid to enter and form a cyst. The treatment entails removal of the overlying loose cartilage, decompression of the cyst, and insertion of bone graft using a curved device, as shown in the images below:

Figure 2 - Bone Cysts in the Hip Socket: Treatment with Arthroscopic Bone Grafting

Figure 3 - Bone Cysts in the Hip Socket: Treatment with Arthroscopic Bone Grafting

Figure 4 - Bone Cysts in the Hip Socket: Treatment with Arthroscopic Bone Grafting

Although this technique is minimally invasive and can alleviate the pain coming from the cyst, it is important to also treat the underlying problem to ensure that the cyst does not recur. In this case, the patient underwent a derotational femoral osteotomy (DFO), following cyst healing, to address the femoral antetorsion as pictured here:

At SCHI we are actively studying the effects of bony alignment on hip pathology and the need for corrective surgery. Our goal is to provide the least invasive treatment option to get rid of your pain and get you back to the active lifestyle that you enjoy!

Click here to open The Evolution of Hip Preservation Surgery video.
Dr. Garabekyan was recently invited to speak at Cedars-Sinai Medical Center Orthopedic Surgery Grand Rounds. The presentation, entitled “The Evolution of Hip Preservation Surgery,” encompassed many years of growth in our understanding of pre-arthritic hip disorders and can be viewed here. One of the most challenging diagnoses faced by hip preservation specialists today is borderline dysplasia or instability of the hip. While some patients with borderline dysplasia may qualify for treatment with minimally invasive hip arthroscopy, others require more advanced bony realignment procedures (PAO/DFO) to achieve a good result. Determining a patient’s candidacy for the minimally invasive approach is a complex process drawing on numerous patient and lifestyle related factors. At SCHI, we specialize in the treatment of complex hip disorders and utilize the latest advances in scientific knowledge to get you the best possible result.

Click here to open Hip Cartilage Tear video.
This intra-operative video shows the appearance of cartilage tears in the hip when viewed through a fiber optic camera during hip arthroscopy. A small probe is used to gently examine the labrum and cartilage to determine the extent of tearing in preparation for repair. The damage seen in this hip is characteristic of hip instability with superimposed hip impingement and gives rise to pain, mechanical symptoms, and giving way. If detected early, hip preservation techniques can be used to repair the torn cartilage and reshape/realign the hip joint through periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO). These cutting edge treatment options help to restore stability, alleviate impingement, and prevent the need for hip replacement.

Read the full article here.

When someone has a flexible joint, we usually ascribe the increased range of motion to ligamentous laxity (i.e. loose ligaments). As it turns out, rotational hip flexibility is largely determined not by the ligaments, but rather by the bony alignment of the femur (ball) and acetabulum (socket). We recently published our results in the prestigious Journal of Bone and Joint Surgery (see link) and I’d like to take a moment to describe the significance of our findings.

You may have noticed that children have a remarkable ability to sit on the floor with their legs rotated out to the sides in what is called the “W” position (opposite of cross-legged). This is because we are all born with our femur bones rotated about 40 degrees to the front. As we mature into adults, our femur bones “derotate” to a final rotation of approximately 15 degrees to the front or 15 degrees femoral antetorsion. This change in rotational alignment also changes our hip’s rotational flexibility, which is why you seldom see adults sitting in the “W” position. In rare instances, the femur bone either fails to derotate or does so excessively resulting in an abnormal rotational alignment with correspondingly abnormal rotational range of motion.

Our study demonstrates that by accurately measuring range of motion in clinic, we can predict the rotational alignment of the bones and take them into account in our hip preservation algorithm. Abnormal femoral rotation may contribute to femoroacetabular impingement (FAI) or hip instability and, if severe enough, corrective surgery (derotational femoral osteotomy (DFO)) may be indicated to restore normal alignment.

Dr. Garabekyan Associations | North Hollywood | Board Certified Orthopedic Surgeon | Glendale Burbank | Encino | Sherman Oaks | Van Nuys

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Hip Pain
(DIAGNOSIS)

Hip Impingement
(FAI)

Hip Instability
(Dysplasia)

Author Archives: Tigran Garabekyan, M.D.

Tigran Garabekyan M.D. – Your Los Angeles Area Hip Specialist

Contact Us

Hip Pain (DIAGNOSIS)

Hip Impingement (FAI)

Hip Instability (Dysplasia)

Tigran Garabekyan M.D. – Your Los Angeles Area Hip Specialist

Contact Us

Hip Pain
(DIAGNOSIS)

Hip Impingement
(FAI)

Hip Instability
(Dysplasia)