What is Hip Arthroscopy?
Hip arthroscopy is a rapidly expanding, new procedure that offers significant and distinct advantages to patients with hip, groin, and buttock pain. It is a minimally invasive way to fix muscle and tendon problems in the hip and to identify and correct structural and degenerative changes in the hip joint.
Hip arthroscopy is a surgical procedure in which a small, flexible tube with a camera attached, called an arthroscope, is inserted into the hip joint. Two or three small incisions are typically made to allow the scope and other surgical instruments to enter a narrow space between the ball and socket of the hip joint. A monitor attached to the camera enables the surgeon to see inside the hip joint to diagnose and even treat certain hip joint problems. This minimally invasive procedure has advantages over traditional open surgery because it causes very little trauma to the hip joint, is generally done on an outpatient basis where patients return home after the procedure, and typically has a short recovery period.
The primary indications for hip arthroscopy are:
- Labral Tears – debridement/repair of labral tears (the labrum is an O-ring of cartilage around the hip socket)
- Cartilage Tears
- Synovitis – removal of pathologic synovium (joint lining)
- Diagnosis – when other means (e. g. MRI) fail.
- Femoroacetabular impingement (FAI)- the removal of painful bone spurs around the hip
- Ruptured Ligamentum Teres
- Dysplasia – a condition where the socket is abnormally shallow and makes the labrum more susceptible to tearing.
- Snapping hip syndromes – cause a tendon to rub across the outside of the joint. This type of snapping or popping is often harmless and does not need treatment. In some cases, however, the tendon is damaged from the repeated rubbing.
- Loose bodies – fragments of bone or cartilage that become loose and move around within the joint.
- Hip joint infection
The benefits of hip arthroscopy:
- Accelerated rehabilitation
- Outpatient hospital visit (average hospital stay is 23 hours)
- Short procedure (approximately 2 hours)
- Less Pain
- Less blood loss
- Less risk of infection
Anatomy of the Hip
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). A tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other. The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket. Bands of tissue called ligaments surround the joint. They form a capsule that holds the joint together. A thin membrane called the synovium lines the undersurface of the capsule. It produces synovial fluid that lubricates the hip joint.
How Do I Know if I’m a Candidate for this Procedure?
Your surgeon may recommend hip arthroscopy if you have a painful condition that does not respond to non-surgical treatment. Non-surgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body’s normal reactions to injury or disease. In an injured or diseased hip joint, inflammation causes swelling, pain, and stiffness. Hip arthroscopy may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. If you have hip pain or a hip injury and do not have severe hip arthritis, you may be a candidate for hip arthroscopy.
How is Hip Arthroscopy Performed?
During arthroscopic hip repair, the patient is anesthetized and the damaged hip is pulled in a controlled way to separate the ball and socket in the hip joint. Through the separation of the joint, the surgeon inserts a tiny camera through the separation via a small incision in the leg.
During the arthroscopic procedure, the surgeons can also insert other instruments into another small leg incision to perform necessary procedures like removing loose bodies or cartilage that has deteriorated. In patients with very early arthritis, surgeons can use hip arthroscopy to remove the bone spurs that are causing the patient pain.
Most hip arthroscopy procedures will require two or three small incisions. In some circumstances, a slightly larger incision may be necessary.
While each hip arthroscopy is specific to the individual patient, certain elements are common to many hip surgeries. These include treatment of the labrum, shaving of the bone, and removal of inflamed tissue.
- Treatment of the Labrum: Labral tears are treated during hip arthroscopy with either refixation (repair of the labral tissue using suture) or debridement (removal of a small portion of the labrum), depending on tear type and the patient’s age.
- Shaving of the Bone: When abnormalities of the bony shape of the hip ball or socket occur, such as in FAI or hip impingement, the most direct way to address the problem is to actually reshape the bone. Specialized bone shavers are used to remove the excess bone and recontour the hip. Portable x-ray is used in the operating room to improve the accuracy of the bone reshaping.
- Removal of Inflamed Tissue: Most of the pain you feel from you hip is due to nerve endings that have become irritated in the presence of inflammation. Much of this inflamed tissue is torn labrum and synovium, the lining of the joint. This inflamed tissue is shaved away during hip arthroscopy.
What are the Risks of Hip Arthroscopy?
Complications from hip arthroscopy are uncommon. Any surgery in the hip joint carries a small risk of injury to the surrounding nerves or vessels, or the joint itself. The traction needed for the procedure can stretch nerves and cause numbness, but this is usually temporary. There are also small risks of infection, as well as blood clots forming in the legs (deep vein thrombosis). There is also the possibility of injury to the articular cartilage of the hip by the instruments used to perform arthroscopy. While this can happen with arthroscopy of any joint, it is more common in arthroscopy of the hip because the joint is more “tight” and difficult to access. This injury is almost
Rehabilitation and Long-Term Outcomes
The surgeon will develop a rehabilitation plan based on the surgical procedures you required. In some cases, crutches are necessary, but only until any limping has stopped. If you required a more extensive procedure, however, you may need crutches for 1 to 2 months. In most cases, physical therapy is necessary to achieve the best recovery. Specific exercises to restore your strength and mobility are important.
Many people return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your hip.
For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). These are decisions you will make with the guidance of your surgeon.
In some instances, the damage can be severe enough that it cannot be completely reversed and the procedure may not be successful.