Hip arthroscopy is a minimally invasive technique whereby it is possible to look inside the hip joint with the aid of a fibre optic telescope and in many instances perform a variety of surgical procedures using that technique. Most people are familiar with knee arthroscopy for the treatment of cartilage and ligament disorders, but hip arthroscopy is a much less common procedure. This is partly because it has taken quite some time for the technique of the procedure to evolve and for there to be the right type of instruments and equipment to facilitate it.
The hip is a much deeper joint than the knee and for that reason it is much harder to introduce the arthroscope into the joint. In order to do this the hip joint has to be distracted by traction to produce enough space to introduce the instruments. Once this has been achieved it is then possible to examine the joint and determine the cause of particular symptoms and in many cases deal with the cause.
Torn Labrum – The labrum of the acetabulum is the cartilage rim of the joint that makes it a bit deeper and helps provide a suction seal for the fluid in the joint. Sometimes this can get torn and lead to episodes of acute pain in the hip with sometimes a feeling of giving way. The torn segment of the cartilage can be trimmed back to healthy tissue.
Loose bodies – Loose pieces of cartilage or bone can sometimes form in the joint for a variety of reasons and these can get caught between the bone surfaces leading to pain . These can be very effectively removed by hip arthroscopy. Arthritis – some early stages of arthritis can be associated with loose bodies or flaps of articular cartilage. Debriding these abnormal areas can often improve symptoms for a while, although it does not get rid of the underlying condition, it can by time before a more definitive procedure is required.
Ligamentum Teres injury – Occasionally a strong ligament with the hip joint can get torn leading to pain. This is amenable to being trimmed back arthroscopically so that it does not cause problems Femoracetabular impingement – this is a condition where there is an abnormal shape to the femoral head and sometimes to the acetabulum (socket). This can give rise to damage within the hip joint. It is possible to deal with some aspects of this condition arthroscopically such as trimming abnormal bumps of bone from the femoral head/neck junction.
Diagnostic – sometimes, even after a number of other investigations such as CT and MRI, it is not possible to be sure what the cause of a problem in the hip is. In these cases it is very helpful to perform a hip arthroscopy.
Biopsy – There may be some conditions of the hip that need a sample of tissue taken to be analysed. Hip arthroscopy allows this to be done quite easily.
The surgery is usually done under a general anaesthetic and instruments are introduced into the hip joint after traction has been applied. Usually two or three small incisions are used. After surgery patients can mobilise the same day and can usually go home the same day. The postoperative recovery programme will depend on what type of surgery was done on the joint and this can be clarified following the procedure.
Most commonly there may be a little numbness around the small incisions which usually gets less with time. Because the hip has to be distracted there is a chance that there will be some numbness in the perineal area. This usually recovers quite quickly but occasionally can persist for a few weeks.