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Hip Arthroscopy
Hip Arthroscopy Information
Hip arthroscopy is an excellent minimally invasive operation that allows thorough visualization of the hip joint needed for diagnosing and addressing various pathology, inside and outside the hip joint. So far there is no radiographic study that is entirely sensitive or specific enough for the diagnosis of cartilage lesions such as labial tears or chondral damage. Hip arthroscopy is a technically demanding procedure, requiring in depth knowledge and requires specialised training and education.
Indications for hip arthroscopy:
- Diagnosis and treatment of labral pathology
- Removal of loose and foreign bodies
- Osteochondral fragments and cartilage flap lesion
- Synovial biopsy or limited synovectomy
- Synovial chondromatosis
- Wash out of infected joint as in septic arthritis
- Evaluation of cartilage quality in avasculara vascular necrosis (AVN) mainly in early stages
- Debridement of ruptured or impinging ligamentum tears
- Assessment of the joint following fixation of a fracture acetabulum or femoral head
- Assessment of a painful hip resurfacing or arthroplasty
- Excision of osteophytes such as Ganz bump and acetabular spurs
- Excision of impinging synovitis such as in case of collagen disease
- Assessment of cartilage condition in dysplastic hip and perthes disease in adolescents
- Debridement, joint wash-out and chondral microfractures which may have a role in management of early arthritis especially in younger patients when it is advisable to delay joint replacement surgery as long as possible
Labral Tears
The acetabular labrum is a fibrous rim of cartilage around the hip socket which helps keep the head of the femur (thigh bone) inside the acetabulum (hip socket). It provides stability and seals the joint.
Acetabular labrum tears (labral tears) can cause pain, stiffness and other debilitating symptoms of the hip joint. The pain can occur if the labrum is torn, frayed or damaged. Labral tears are most often casued by trauma or developmental hip dysplasia.
Labral tears are extremely common in elderly people and less common in young adults.
Symptons:
- Pain in the front of the hip (most often in the groin area) accompanied by clicking, locking or catching of the hip
- Joint stiffness and a feeling of instability
- Pain that radiates to the glute, along the side of the hip or down to the knee
- Pain may be aggravated by long periods of standing, sitting, or walking, worse on flexion. May progress to become continuous
Contraindications:
Arthroscopic debridement treatment is not advised if you have any of the following conditions:
- Advanced hip arthritis
- Acetabular protrusion
- Hip ankylosis
- Skin lesions at portal sites
Surgical Procedure:
The patient will be admitted into hospital for a day or overnight. The procedure is performed either under general anaesthesia or spinal anaesthesia.
At the start of the procedure, the leg is put in traction. The hip is pulled away from the socket enough for the entire joint to be visible and for instruments to be inserted.
A small puncture (about the size of a button hole) is be made for the arthroscope through which the inside of the hip and its damage can be identified. X-ray control using an image intensifier is used to gain access to the joint.
Two or three small incisions (portals) are made just above the bony prominence of the hip and instruments are inserted; first to visualise and treat any spurs on the femoral neck or acetabulum and then traction is applied where the instruments gain access to the hip joint to treat any pathology intra-articulary on the hip. These instruments can also smooth off rough surfaces, remove loose pieces of cartilage and excise bony osteophytes that may be causing a problem.
Sufficient traction is applied to open the joint by 7-8mm.
Local anesthetic is injected into the hip and wound following the procedure.
Depending on the approach taken and the individual condition the above overview may vary.
Complications:
As with any operation complications are possible but unlikely. Such complications associated with hip arthroscopy can include:
- Nerve injury – the pudendal nerve may be damaged by the traction post. This is usually temporary and rarely permanent.
- Permanent damage to the lateral femoral cutaneous nerve may occur in around 2% of patients.
- Inadvertent chondral damage.
- Infection in the skin or deep in the hip in less than 1% of patients.
- Vascular injury; resulting in excess bleeding.
- Ongoing pain; especially if there is significant arthritis.
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