Overview of Hip Arthroscopy
First developed in 1931, arthroscopy of the hip has had a slower evolution than that of the knee due to the difficulty of using the straight arthroscope (camera) within spherical hip joint. However, specialist instruments have been developed in the last few years to aid the procedure and allow useful therapeutic interventions to take place.
I perform the vast majority of my hip arthroscopies as daycase surgery, and have a widespread network of trusted and experienced physiotherapists around the city and region (I receive many tertiary referrals from colleagues all over the Southwest). Patients will have two (occasionally three) small (1-2cm) scars and through these I am able to treat labral tears (in most cases repairing the damaged tissue), CAM and Pincer lesions (hip impingement), and removing damaged and irritated tissue such as diseased synovium, or releasing troublesome tight tendons, even after hip replacement surgery.
Afterwards I provide a pictorial record of your hip procedure, and you spend 10-14 days on crutches until the wounds heal. Simple ‘muscle activating’ and ‘range of motion’ exercises are provided for the first two weeks, and then a graduated rehabilitation programme can be instigated. Patients often return to football, running, cycling, gym work, and horse riding within 3-6 months.
So when can hip arthroscopy be useful, and which conditions can it help?
Symptomatic hip disease from the following:
- Tears of the Acetabular Labrum (cartilage lip around the cup)
- Impingement lesions (CAM or pincer) of the femoral neck and/ or acetabulum (bony lumps around either side of the hip)
- Tendon snapping
- Localised cartilage damage
- Trochanteric bursitis (pain on the outside of the hip, often restricting ability to lie on one’s side)
An X Ray of Hip DiseaseWith modern equipment and techniques, it’s possible to repair or reset torn labrum, burr away femoral neck bumps, recess acetabular overhang (pincer lesions), remove loose and foreign bodies.
Occasionally, arthroscopy can be useful in the hip where diagnosis is a problem despite traditional investigations.
Often a patient’s history will provide clues as to the diagnosis. For instance, pain during driving and pain associated with certain sporting activities can suggest labral tears, impingement lesions or both.
Examination can help to confirm, and X-rays can be diagnostic for bony lesions, and help exclude arthritis as a cause.
The gold standard investigation however remains the Gadolinium enhanced MRI scan. This very clearly shows the soft tissue structures around the hip and can also inform us about the more unusual diagnoses such as inflammatory arthropathy, and avascular necrosis.
You will be assessed carefully in the outpatient department. Once the diagnosis is clear and as long as hip arthroscopy offers a surgical solution, then an operation date will be arranged. Pre-assessment will take place shortly before surgery to determine your general medical health and you will likely be admitted on the day of surgery.
Your stay in hospital will either be a single day or, more commonly, overnight. General anaesthesia is used as you must be fully muscle-relaxed to allow a satisfactory view inside the hip.
The arthroscope is introduced through one of normally two, rarely three, portals, each measuring around one to two centimetres. These are located on the side and to the front of your greater trochanter (the prominent bone on the outside of the hip).
The Hip Arthroscopy Procedure
We have a careful look throughout the hip joint and, if suitable for treatment, thin guided instruments are introduced to allow removal, release or fixation of tissues.
Occasionally, if a lesion is in a difficult to access area within the hip, or is just too large to be addressed by the arthroscopic method, a small wound may be made on the front of the hip to allow a limited ‘open’ procedure to take place and achieve the desired result.
Local anaesthetic is instilled as we leave the hip joint and small sutures will close the wounds.
The patient is mobilised later the same day, soreness allowing, and often uses crutches for one to two weeks to allow the wounds to settle and heal.
Intensive physiotherapy and personal exercises are important to regain early hip movement and to prevent scarring from restricted motion. Return to sporting activities is usually around eight to twelve weeks but, depending on the amount of treatment required within the hip, may take as long as six months. Occasionally damage is found within the hip that is not treatable by ‘conservative’ means and other methods such as hip replacement options may need to be discussed at a later date.
Hip Arthroscopy Complications
These are reasonably rare, but include sensory loss on the outer thigh, infection and thrombosis. Failure to improve can also be a problem, but the chance of a positive outcome varies with each individual case and diagnosis. Mr Eastaugh-Waring will talk to each patient about their likely chances of success.
Talk to us about Hip Arthroscopy
To talk about hip arthroscopy treatment please get in touch using our contact page.