Hip Arthroscopy

Hip arthroscopy is a recently developed, surgical technique to treat specific disorders of the hip. It has been present in the orthopedic community for approximately 13 years. Because of its technically demanding nature and limited indications, hip arthroscopy is not a common procedure for an orthopedic surgeon to perform. To clarify, arthroscopy is the examination of the interior of a joint using an endoscope that is inserted into the joint through a small incision.

The two main indicators for hip arthroscopy are loose bodies of cartilage or bone in the hip and labral tears of the acetabulum (hip socket). Patients with loose bodies describe it as "hip catching." The labral tissue is connective tissue that surrounds the outer acetabular rim and helps to contain the hip and contain the vacuum effect of the hip. This area can tear causing pain. A labral tear usually presents itself with a sudden groin pain caused by a variety of activities. A labral tear is found when hip flexion and internal rotation reproduces the hip pain. Infection can also occur in the tear area causing hip redness and pain with any motion.

It should be noted that neither osteoarthritis nor rheumatoid arthritis can be treated with hip arthroscopy. Additionally, hip arthroscopy is not an appropriate procedure to use to diagnose hip injuries/pathology. Hip arthroscopy can also be used to clean out infected hips.

There are two special tests to help the surgeon decide if hip arthroscopy is necessary. One is a plain x-ray of the hip, which is usually normal. The second and best test is an MRI of the hip with gadolinium injection (dye-like substance) by fluro-assisted arthrogram.

If the patient's clinical exam and special tests indicate surgery, then they are set up for arthroscopy. The procedure begins with a general anesthetic or spinal anesthetic depending upon the patient's preference and medical condition. The spinal technique allows the patient to watch the surgery on the monitor. They are lying down, face up, on a fracture table. The painful leg is draped free. This allows the surgical assistant to pull the leg and position the hip where the surgeon wishes. Hip arthroscopy is difficult because the scope has to go directly into the injured area. The surgeon cannot move the instruments around; the hip has to be moved to the surgeon. The scope has 30° and 70° angles to help see around corners. Once in position, the loose bodies are removed; the tears are shaved and then made smooth with a thermal probe. Arthroscopy allows for this procedure to be treated on an outpatient basis, eliminating the need for hospital stays and allowing the patient to recuperate in the comfort of their own home.

Rehabilitation after the surgery has very few restrictions. The patient can resume activity immediately, including fully weight bearing activity. Bike or pool exercises can be started as soon as possible as well as weight training. Running is discouraged for future prevention of further hip injury, but if the patient wishes continue, running can be resumed in 6 – 8 weeks.

The results of this surgery have been highly successful. In my practice 90% of the people improve to excellent results and return to their sporting activities. It is an amazing thing to be able to take a painful hip and, through 2 or 3 small incisions, give the patient excellent pain resolution with an outpatient treatment.