What is hip arthroscopy?
Arthroscopy of the hip uses specialized arthroscopic instruments to
treat various unusual disorders of the hip.
What procedures can be performed
in the hip arthroscopically?
The primary indications for hip arthrsocopy are removal of loose bodies
(usually cartilage), debridement/repair of labral tears (the labrum is an O-ring
of cartilage around the hip socket), removal of pathologic synovium
(joint lining), and rarely, for early stages of hip arthritis. In addition,
sometimes hip arthroscopy can provide a diagnosis when other means (eg.
MRI) fail. Recently, hip arthroscopy with thermal shrinkage has proved
useful in persons with instability of the hip. The most exciting new use of hip arthroscopy is to treat a problem called femoroacetabular impingement - the removal of painful bone spurs around the hip.
How does my doctor decide if I need
Usually, this surgery is indicated in people who have pain that can
be localized to the hip, but with minimal findings on x-ray. As such,
many of these problems can be hard to define, and patients occasionally
go months to years without a specific diagnosis, especially if the physician
does not have a lot of experience with these diseases. Some diagnoses
(synovial chondromatosis, polyvillonodular synovitis) can be made using
special studies like CT scans or MRIs. Other problems, such as tears
of the acetabular labrum, might not show up on any of the tests and
can only be diagnosed with physical examination, listening to the patient
history, and exclusion of other diseases.
Why don't more surgeons perform
The indications for it are quite limited - i.e. there aren't that many
patients who need this surgery. In addition, it is more difficult than
arthroscopy of the knee or shoulder because the hip is more deep, surrounded
by important nerves, and is therefore harder to access. Finally, special
instruments are needed to do the procedure. For these reasons, most
orthopedic surgeons do not have much, if any, experience with this procedure.
How is hip arthroscopy performed?
The patient, after being anesthetized, is placed in traction on a specialized
operating room table. The traction is necessary to pull the hip apart
slightly to allow us to insert instruments into the joint safely, without
injuring the cartilage. All this is done with the help of a portable
xray machine to make sure the instruments are positioned correctly.
A pump device is used to fill the joint with saline. Then an arthroscope
is used to view the joint; once a problem is identified, it is treated
with a variety of instruments.
What are the risks of hip arthroscopy?
Probably the most common risk is injury to the articular cartilage
of the hip by the instruments used to perform arthroscopy. While this
can happen with arthroscopy of any joint, it is more common in arthroscopy
of the hip because the joint is more "tight" and difficult
to access. This injury, however is almost always minor and inconsequential
(because the instruments we use are relatively small and the cartilage
of the hip joint is quite thick). Swelling is also a common occurrence
- this usually resolves within a week. Nerve injuries can occur because
of the traction used in surgery - usually these injuries are not permanent,
however. With modern instrumentation, and an experienced surgeon, the
complication rate of this procedure is very low.
What is the success rate of the
That depends on the diagnosis that is being treated. Our current research
indicates that treatment for loose bodies (trauma, synovial chondromatosis)
has excellent results and arthroscopy for labral tears has good results
if there is only minimal arthritis present. Results for treatment of
arthritis are less promising, however, with only a subgroup of patients
receiving adequate relief of pain - usually these patients benefit more
from a hip replacement. Patients with arthritis who benefit from this
procedure typically have very mild arthritis, usually with some other
problem, such as a labral tear.
What is the recovery from hip arthroscopy?
Generally, most patients have the surgery performed on a same day basis
- no overnight stay in the hospital is required. Often patients are
able to tell that night or the next day that their hip feels better.
This is usually followed by a recurrence of the pain, which lasts a
few weeks, then gradual resolution of the pain. This recurrence is usually
from bleeding into the joint after surgery causing irritation of the
joint lining. Patients are given crutches in the hospital and are allowed
to weight-bear as tolerated. Usually, physical therapy is not needed.
Swelling around the hip, groin, and leg resolve usually within a week.
Sometimes, your knee might feel sore - because we pulled traction on
your hip via your foot, it necessarily pulls on your knee also. This
discomfort, if present, is also temporary.
What experience does Advanced Orthopedic
Specialists have with hip arthroscopy?
Dr. Farjo trained with the physicians who helped develop and popularize hip arthroscopy in the 1990's. Since then, he has extensively performed, researched, lectured, and published
about hip arthroscopy, including its use in the treatment of labral
tears, debridement of arthritis of the hip, femoroacetabular impingement, and general outcomes of
the procedure. He is one of the few surgeons in Michigan to regularly perform hip arthroscopy. Click on the links below to read more about his research:
- Hip arthroscopy for Labral
arthroscopy for Degenerative Joint Disease (arthritis).