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Bahri Orthopaedics

Hip Arthroscopy

Hip arthroscopy is a surgical procedure that allows physicians to see internal structures of the hip joint in a minimally invasive manner. This is performed with a camera, monitor, and specialized instruments. Hip arthroscopy has been performed for several years, though it is much less commonly done than knee and shoulder arthroscopy. Due to the complexity of hip arthroscopy, your surgeon shoulder possess additional skills and training with regards to this powerful technique.

figure 1: Hip Arthroscopy

 Figure 1

Anatomy

The hip is a ball-and-socket joint. The ball, also known as the femoral head, articulates with the socket (acetabulum). The femoral head and acetabulum are lined by articular cartilage to create a smooth, frictionless environment that helps the two ends of the joint glide with ease. The acetabulum is also supported by the labrum which lines the periphery of the socket. Additional bands of tissue called ligaments help form the capsule that holds the joint together. The interior surface of the capsule is lined by synovium which produces fluid that lubricates the hip joint (Figure 1).

Reasons for hip arthroscopy

Hip arthroscopy may be performed for painful conditions that do not respond to nonsurgical treatment. Nonsurgical treatment options include rest, medications, physical therapy, and joint injections. Hip arthroscopy may address symptoms of related to injuries involving the labrum, articular cartilage, and other soft tissues surrounding the joint. There are specific conditions as listed below that can be addressed with this type of surgery:

  • Femoro-acetabular impingement (FAI) is a disorder where osteophytes (bone spurs) around the socket or the femoral head cause damage.
  • Dysplasia is a condition where the socket has developed abnormally, making the labrum more susceptible to tearing.
  • Synovitis involves inflammation of the synovial tissue.
  • Loose bodies are small portions of bone and/or cartilage that become loose and circulate within the joint.
  • Hip joint infection

figure 2: Hip Arthroscopy

Figure 2

Surgery

After you have received anesthesia, your leg is placed into traction to allow your surgeon to insert instruments, visualize the hip joint, and perform the necessary surgical repairs. Similar to the shoulder and knee, small puncture wounds are made around the hip. Through the arthroscope, your physician can view the inside of your hip and correct the problem (Figure 2). Your surgeon may insert other instruments through separate incisions to address the problem. This procedure can remove or repair torn cartilage, shave bone spurs seen in FAI, and removal inflamed synovial tissue. Complication rates from hip arthroscopy are low, but as with any surgery there remains a small risk of injury to the surrounding nerves , vessels or hip joint. The traction required for the procedure can stretch nerves and cause temporary numbness. Other uncommon risks include infection and blood clots forming in the legs (deep vein thrombosis).

Rehabilitation

Your postop rehabilitation program is based on the surgical procedure performed. Crutches are often necessary to protect the hip during the initial healing period (i.e. bone shaving). If more extensive procedures are performed (i.e., labral repair), you may need crutches for 4 to 8 weeks. Physical therapy is usually necessary to achieve the best outcome. Your surgeon and physical therapist shoulder maintain an open dialogue to assist you in your recovery.