Hip arthroscopy involves the use of an arthroscope to visualize the inner workings of the hip joint through a minimally invasive technique. Once general or spinal anesthesia has been achieved, traction is applied to the hip so that the femoral head (ball portion of the hip joint) is slightly distracted out of the acetabulum (socket portion of the hip joint). The amount of distraction is closely monitored during surgery with the use of X-ray. Two to three incisions, each measuring ½ inch in length, are placed over the outer aspect of the hip with the patient positioned on their side. Specialized instrumentation for hip arthroscopy is utilized to visualize the interior of the hip joint. Hip arthroscopy permits the surgeon to diagnose and treat a wide array of problems within the hip, which in the recent past has required extensive incisions and surgical exposure that prolonged recovery.
Patients with symptoms of hip pain that have not responded to conservative treatment and have not had a cause demonstrated by standard radiographs, may be candidates for a hip arthroscopy. In addition, sensations of “popping”, “catching”, “snapping”, or “clunking” in the hip joint can be treated with an arthroscopic procedure. All of the above symptoms can be caused by a loose body in the hip joint, by a tear in the lining of the rim of the hip socket, or secondary to an inflammatory or degenerative condition in the hip. A preoperative MRI with gadolinium or hip arthrogram can help to confirm the diagnosis of these problems prior to the arthroscopy. Arthroscopy has also been used to diagnose and evaluate diseases such as Rheumatoid Arthritis, Juvenile Rheumatoid Arthritis, Perthes Disease, Synovial Chondromatosis, and Ankylosing Spondylitis of the hip.
Hip arthroscopy is a relatively new technique to treat patients with intra-articular diseases within the hip joint. Because of its complex nature it should only be performed by an orthopaedic surgeon specially trained in hip arthroscopy and most are fellowship trained in joint reconstruction. Dr. Steven Wardell meets both of these criteria and serves as an Associate Master Instructor in Hip Arthroscopy at the annual Arthroscopy Association course teaching surgeons from around the world.
With proper surgical technique, the incidence of complications in hip arthroscopy is very rare. Complications with any surgical procedure can include infection, nerve injury, and incomplete relief of pain. Temporary neuropraxias (numbness) can occur secondary to the amount and duration of traction used during the procedure. The amount of traction time is closely monitored throughout the procedure to minimize the incidence of nerve injury.
Patients undergoing hip arthroscopy go home the same day the surgery is performed. They are discharged with crutches to aid initial ambulation, but they can place as much weight as they can tolerate on the affected hip. Because sterile water is used to distend the hip capsule during the procedure, some postoperative pain is to be expected. Patients are sent home with prescription pain medication to help with this pain which should last only a few days. Generally, patients can discard their crutches within a few days of surgery and may return to work within a week or as the pain allows.
Physical therapy is generally required to help return a patient back to work and sports sooner. Therapy programs include both the use of pool and land therapy and generally is prescribed three times a week for three to four weeks.
Patients without arthritis who have acetabular labral tears or loose bodies, often have excellent results. It has been reported that some patients do not improve after excison of diagnosed labral tears or loose bodies. This most commonly occurs in the case of significant, coexistent severe degenerative arthritis in the hip joint. However, surgical outcome can usually be predicted with appropriate examination and review of both an x-ray and/or MRI before surgery.