Arthroscopy is now the gold standard for Knee, Shoulder Wrist Elbow and Ankle surgery, It is now being increasingly used both for surgery in and around Hip.
It is also effective as a day case treatment of most conditions around the young adult hip and the elite sportsman.
Within the discipline of sports medicine, the hip has received considerably less attention than other joints, largely because of the difficulty that practitioners have traditionally had in assessing intra articular abnormalities around the hip. Over the past few years, hip arthroscopy has been gaining considerable interest. The advent of better diagnostic tools, especially MRI, has helped in the detection of hip Labral tears in a more predictable fashion. New techniques and instrumentation have facilitated the treatment of Labral tears by hip arthroscopy. Most notably, the recent adaptation of arthroscopy instruments specifically designed for the hip has led to improved safety, visualization, and accessibility of this joint.
Athletes subject their bodies to extreme forces; their lower extremity joint may experience joint reactive forces in excess of five times body weight during activities such as running and jumping. The mechanisms of injuries can be from repetitive motion or direct trauma.
The hip joint is the largest ball and socket joint in the body and goes through seven million movement cycles per year in the average person. The hip joint can be prone to wear and tear and arthritis in older individuals. However, younger people can also develop a variety of hip joint problems that can affect walking, running, sport and daily activities.
Advances in technology and an increased awareness of pathology have allowed us to investigate and image problems of the hip joint with a new degree of accuracy. Scans such as MRI-arthrograms can show tears of the cartilage within the hip joint clearly.
The word 'arthroscopy' means literally 'looking into the joint'. Knee arthroscopy was first introduced into the UK in the 1970s and is now one of the most commonly performed orthopaedic operations. Arthroscopy of the hip joint is a much newer procedure due to the added technical complexities, and is currently only being performed by relatively few orthopaedic surgeons.
Problems in the hip joint that can potentially be treated by arthroscopic surgery of the hip include:-
Gluteal Medius Tears
Loose bodies (loose bits of cartilage floating around inside the joint)
Chondral damage (wear and tear of the layer of cartilage covering the bone)
There is a wide variety of different symptoms that these pathologies in the hip joint may cause, including:-
Pain in the hip (often felt in the groin)
Clicking within the joint
Giving way (where the leg just 'gives out')
Discomfort when moving the hip into certain positions (especially lifting the knee up and rotating the leg inwards)
Stiffness of the joint
Difficulty walking or running
Traditional open surgery of the hip joint is a major procedure and involves large cuts through the skin and the muscles to get to the joint. Arthroscopy of the hip, however, allows the joint to be visualized with tiny telescopes and cameras and for pathology within the joint to be treated with specialized probes, through tiny skin incisions with minimal damage to the tissues.
This is now the preferred option of diagnosing treating and managing hip pathology of the relative young adult, There is also now evidence that early arthritis of hip Impingement decompression can delay Hip replacement surgery for up to 5 years in 60-70% cases.
Traction table to distract Hip Joint
Hip arthroscopy is performed under a general anaesthetic. The patient's leg is strapped into a traction table that gives distraction of the hip joint, pulling the joint open in order to allow the passage of the arthroscope (a small rigid telescope with a digital camera on the end) into the space between the ball (femoral head) and socket (acetabulum) of the joint. Small probes and other specialised instruments that can be introduced into the hip joint to allow a wide variety of different surgical procedures to be performed.
I use the Smith and Nephew access system and found it to be excellent.
Central Compartment Portals Lateral Compartment Portals
Patients are operated upon as Day Surgical Procedure but depending on recovery some are kept in hospital overnight, after hip arthroscopy surgery, but are normally able to go home the following day. Post-op, patients are normally allowed to partially weight bear, with the help of a crutch. However, after hip arthroscopy you are normally advised not to run or do sport for at least 6 weeks, to allow the joint to recover from the operation first. If more major pathology is found within the hip joint and more major procedures are performed, then sometime it is necessary to protect the joint by resting it and avoiding running for up to 3 months.
If you have a hip arthroscopy then I will advise you of exactly what I found inside your hip, what was done, and therefore what rehab will be necessary for you individually.
Although Hip Arthroscopy surgery is regularly performed without any complications, it is very important that all candidates are fully aware of both the benefits and risks of undertaking this type of specialist surgery.
All surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation with an expert in Hip Arthroscopy surgery to discuss your condition in relation to these risks cannot be over emphasised.
The most concerning complications of hip arthroscopy have to do with several important nerves and blood vessels that surround the joint. Nerve injury is uncommon, but can be a significant problem. The most commonly affected nerves include the sciatic nerve, the lateral femoral cutaneous nerve (sensation to the thigh), and the pudendal nerve. Injury to any of the nerves can cause pain and other problems.
Other possible complications from hip arthroscopy include potential injury to normal structures, infection, and continued pain after the surgery. The rate of these complications is low, but patients need to understand the potential prior to undergoing a hip arthroscopy.
Recently I have started to scope the lateral compartment with the patient lateral with no fracture table and no need for imaging.
Pictures from Hip Arthroscopy Xray during procedure
Hip arthroscopy cannot treat all hip disorders. Nevertheless, hip arthroscopy has proven to be very effective in the treatment of many hip problems, which are outlined elsewhere on this website. Depending upon the cause of your hip pain, hip arthroscopy may greatly relieve your pain and discomfort. For some patients, hip arthroscopy may delay or eliminate your need for a total hip replacement in the future.
Labral Tear Lig Teres Tear
Loose Body Removal
Loose Body with Synovitis Synovial Impingement
Trochanteric Bursitis After Bursectomy
I have been performing hip arthroscopy since 2007. I have helped many patients return to a pain free lifestyle. I have been trained in hip arthroscopy by the professors and fellow surgeons who are the pioneers in this rapidly evolving field. I continue to keep current with the latest advances in hip arthroscopy, by attending continuing educational courses hosted by the worldâ€™s foremost experts.
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