Hip Arthroscopy

Information

What does hip arthroscopy involve?

Hip arthroscopy is a complex technique. The distance between the ball and the socket of the hip joint is very small, and until recently doctors believed it was impossible to place a needle in this location. Today it is possible to see inside the hip joint using a special technique and a small endoscopic camera. Small surgical instruments can also be used for treatment purposes.

Hip arthroscopy is a minimally invasive procedure. The use of an arthroscope means that the procedure is performed through 2-3 small incisions (about 4-5 mm long), unlike the more invasive open surgery, which requires a much larger incision. These small incisions (access points) are used to insert the surgical instruments into the joint.

Among the advantages of the arthroscopic technique is that the manipulation is performed in a fluid medium (a special solution), which gives the surgeon an excellent view of the intra-articular structures and reduces tissue trauma. A portable X-ray device is also used to ensure that the instruments and the arthroscope are correctly positioned. Hip arthroscopy usually takes between 45 minutes and 2 hours, depending on the complexity of the operation.

The procedure is performed as an "outpatient" surgical intervention, meaning that the patient undergoes surgery in the morning and goes home later the same day. The patient is usually under regional (spinal) anesthesia. In this way, they are immobilized only from the waist down. Sometimes, if there are additional indications, it may be performed under general anesthesia.

Traditional open hip surgery is a major procedure and involves large incisions through the skin and muscles in order to reach the joint. Hip arthroscopy, however, allows the joint to be visualized with small telescopes and cameras, and the pathology of the joint to be treated with miniature instruments through skin incisions, with minimal tissue damage.

What conditions can be treated with hip arthroscopy?

Hip arthroscopy can be used to treat several conditions that may result from sports and everyday injuries, avoiding the need for more serious hip surgery:

• Labral tears - can be easily seen and, in most cases, can be repaired during the procedure;
• Cartilage damage - damage to the smooth cartilage covering the hip joint - can be removed;
• Loose bodies in the joint - are identified and removed;
• Snapping hip syndrome - for example, when the tendon at the front of the hip snaps over the bone. This can be treated during hip arthroscopy by releasing the tendon or by treating the underlying tear in the cartilage that is responsible for the tightening of the tendon. There are also a number of other causes of a snapping hip, most of which can be treated arthroscopically.

How do I know if I need the surgery?

This surgery is usually appropriate for people who have pain localized to the hip, but with minimal X-ray findings. Many of these problems are difficult to diagnose, and sometimes patients go anywhere from one month to several years without a specific diagnosis, especially if the doctor does not have extensive experience with these conditions. Some diagnoses (synovial chondromatosis, pigmented villonodular synovitis, femoroacetabular impingement - FAI syndrome, and others) can be made using special investigations such as computed tomography (CT scan) or magnetic resonance imaging. Other problems, such as labral tears, may not be visible on these tests and can only be diagnosed through a physical examination, a carefully taken patient history, and by ruling out other causes (differential diagnosis).

Possible complications

Hip arthroscopy is a relatively safe procedure. The most common adverse reactions are discomfort around the hip area; numbness around the groin is observed in about 5% of cases. Serious complications such as infection, bone fractures, or permanent nerve damage are extremely rare.

Recovery process

Overall, most patients undergo surgery as a day procedure and do not need to stay overnight in the hospital. Patients often report feeling better that same night or the following day. This is usually followed by a recurrence of pain that lasts several weeks and then gradually subsides. The recurrence of symptoms is usually due to bleeding into the joint after the surgery, which causes irritation of the joint lining.

After the procedure, patients are usually given crutches for a few days to minimize weight-bearing. A follow-up examination is carried out in the week after the surgery to remove the stitches. After this examination, the patient usually starts physical therapy, which improves the strength and flexibility of the hip.

After six weeks of physical therapy, most patients resume their normal activities, but it may take 3-6 months for pain after physical activity to stop.

Most patients are able to drive the following day. Office workers may return to work as early as 1-2 weeks after arthroscopy, while those engaged in heavy physical activity may need 6 weeks off work. Sports activity is often resumed within 4-6 weeks. 80% of professional athletes return to their usual level of fitness within 16 weeks. In a small proportion of patients, mild persistent discomfort may remain for up to 3-4 months after the procedure, depending on the degree of joint damage.

Advantages of hip arthroscopy

Studies show that 85-90% of operated patients return to their sports and other physical activities at the level they were at before the onset of hip pain. Most patients improve significantly, but it is still not clear to what extent hip arthroscopy prevents the onset of arthritis. Patients with skeletal deformities or degenerative conditions may not experience the same relief from the procedure as a patient with a simple injury.

The benefit of hip arthroscopy is that recovery is much faster than with open hip surgery. Patients can bear weight according to their hip's tolerance immediately after the surgery.

Hip arthroscopy is recommended when conservative measures fail to relieve the symptoms associated with FAI - a condition that was not well understood or well treated in the past. These advantages have made hip arthroscopy a safe and effective alternative to open hip surgery, which is a huge advantage in treating early-stage hip problems that could otherwise develop into advanced-stage arthritis over time.