Hip Arthroscopy [Looking into the Hip with a key-hole camera]

Hip arthroscopy has been around for a long time. Historically, it did not have many devoted adherents because it is technically difficult, requires quite forcible traction on the leg and the instruments available were crude or custom-made for individual surgeons. There was also a wide-spread belief that hip arthroscopy might be useful for diagnostic purposes, but there was little place for therapeutic intervention.

The advent of better imaging techniques, more reliable, clever and miniaturized instruments plus a greater insight into early hip disease patterns has triggered a surge of interest in the technique.

Like knee arthroscopy, hip arthroscopy is not a single 'operation'. It is a technique which surgeons can use to perform a variety of different tasks or therapeutic procedures. The results will vary widely depending on the underlying disease or condition and whether there are any degenerative changes already present. The skill and experience of the surgeon will also influence the outcome.

The great advantage of all arthroscopic techniques is that they are truly minimally invasive and patients can be discharged within 24hrs of admission. It is possible to cause harm, but very unlikely in properly trained hands.

What can be treated by hip arthroscopy? A wide range of conditions, but the most common indications would include:

Labral Tears

Femoro-acetabular impingement (FAI).

Loose bodies in the hip

Psoas tendonitis, especially after hip replacement or hip resurfacing.

Early degenerative change (early OA).

The list is not complete or exhaustive! What does NOT respond well is advanced hip arthritis with complete joint space loss, large osteophytes, deformity and contractures. Such cases need an arthroplasty i.e. a Total Hip Replacement (THR) or a Resurfacing.

Hip Arthroscopy : How it is done.

The patient is placed supine or in the lateral position with traction applied to the operated leg. The traction required is considerably greater than orthopaedic surgeons are used to employing in other circumstances eg for the fixation of femoral fractures. There is a definite risk of traction or pressure injuries to the groin, the foot or ankle and other tissues including the nerves which supply the leg. Careful positioning and padding is essential, as is limiting the traction time during surgery.

X-ray imaging is used to identify the hip joint and pass gradually increasing diameters of needles, wires and trochars until the hip can be entered with a telescope on the end of which is a video camera. This process is termed creating a 'portal' or entry point through the skin and other tissues down to the hip itself.

Fluid under pressure is used to distend the joint and keep the field of view clear of blood. Additional portals are created as required. The hip joint is deep and there are important or vulnerable structures which must be avoided! So the process takes time, experience and patience.

Once the hip can be clearly visualized, the surgeon can employ a variety of tools and techniques to address the problems found.

A further twist is that the hip has 2 major compartments. The internal or xxx and the external (outside the labral edge). The external compartment can be reached without traction, so it is usual to deal with any problem here last, or after the internal compartment has been checked.

Possible complications of hip arthroscopy:

Bruising and swelling, transient numbness or transient ache in knee and ankle. These are common, resolve quickly and are therefore essentially harmless.

The following are all rare:

Infection

Major nerve or blood vessel injury (direct or by traction)

Deep vein thrombosis / embolism