Hip arthroscopy

Hip

Arthroscopy is the examination of the inside of a joint using an arthroscope or "scope," a flexible fiber-optic tube with a small camera attached to a monitor. This allows the surgeon to see a magnified view of your joint. Specially designed arthroscopic surgical tools are also used to perform different types of minimally invasive joint surgery.

Hip joint arthroscopy was perfected in the late 1980s and early 1990s. Since then, the development of advanced arthroscopic surgical equipment has enabled orthopedic surgeons to treat conditions that were previously intractable or required procedures. more invasive open
 

What is hip arthroscopy?

Hip arthroscopy, sometimes called a "hip endoscope," is a minimally invasive procedure in which an orthopedic surgeon uses an arthroscope to examine the inside of the hip joint.

This procedure allows the surgeon to diagnose the cause of hip pain or other joint problems. Some hip conditions can also be treated through arthroscopy. To perform arthroscopic hip surgery in these cases, the surgeon makes additional small incisions (usually one or two) to create access points for various arthroscopic needles, scalpels, or other special surgical tools.
 

What are the advantages of hip arthroscopy?

A hip endoscope has several advantages over traditional open hip surgery, because:

• Causes very little trauma to the joint (minimizing hip pain and scarring) 
• Usually done on an outpatient basis (where patients go home after the procedure) 
• Usually has a short recovery period 
• Can delay the progression of arthritis from hip by treating its cause in the early stages 
• You can delay or eliminate the need for hip replacement by treating preemptively the conditions that cause osteoarthritis of the hip
   

What hip conditions can be treated by arthroscopy?

Common injuries and conditions that can be corrected with arthroscopic hip surgery are:

• Impingement of the hip (femoroacetabular impingement), which limits range of motion and is a leading cause of osteoarthritis
• Repair or trimming of a labral tear, where a specialized cartilage called the labrum, which lines the hip socket, is torn
   

Removal of:

• Loose fragments of cartilage within the joint (which are usually caused by an injury, such as a torn labrum) 
• Diseased or inflamed joint lining 
• Painful bone spurs

Is hip arthroscopy right for you?

To determine if a hip arthroscopy is right for your situation, your doctor will first:

• Know your symptoms and medical history 
• Review your images (X-rays, CT scans, and/or MRIs) 
• Perform a physical exam, which may include range-of-motion tests
   

Overview of a Hip Arthroscopy Procedure

Arthroscopic hip surgery is usually performed on an outpatient basis, where the patient returns home the same day as surgery. Depending on your doctor's findings and the type of treatment to be performed, arthroscopic hip surgery can take anywhere from 30 minutes to two hours.
 

Preparation

Before the procedure, you will be given anesthesia to prevent the sensation of pain. You may have general anesthesia, in which a gas puts you to sleep, or regional anesthesia, in which an injection or a small tube (catheter) delivers medicine to your spine, making you numb from the waist down.

In most cases, you will be placed with your leg pulled in traction. This creates space in the hip joint and allows instruments to access the joint without damaging the surrounding cartilage. Accessing the narrow space of the hip joint is complicated by the orientation of the surrounding nerves and blood vessels. To ensure that the arthroscope and instruments are inserted correctly, a portable x-ray device called a fluoroscope will be placed for use during the procedure.
 

Incisions and access to the joint

Your surgeon will make two or three small incisions, one-quarter to one-half inch long, called portals, along the previously marked sites.

First, a needle will be inserted into the joint space, and when position is confirmed under fluoroscope, a sterile, water-based solution will be injected into the joint, creating fluid pressure to help keep the joint open. . An incision is made and a guidewire is passed through the needle, which is withdrawn.

Next, a thin tube, called a cannula, is inserted over the guide wire into the joint space. The wire is removed and an arthroscope is inserted through the cannula to visualize the joint. The other one or two portals are accessed in a similar fashion and, once completed, the location of the arthroscope or instruments can be changed to view the joint or repair tissues from a variety of positions. Fluid can enter and leave the joint through attachments on the arthroscope or through other portals to facilitate visualization of the interior of the joint.

Diagnosis and surgical repairs.

Typically, your surgeon will examine the condition of the articular cartilage that covers both the ball head of the hip (the femoral head, located at the top of the femur) and the interior of the socket (the acetabulum). This cartilage allows the surfaces of the bones to glide across each other smoothly. Your surgeon will also examine:

• Condition of the ligaments that attach the bones to each other 
• The firm ring of cartilage that surrounds the hip socket, called the labrum, to look for a hip labral tear 
• Space within the joint to determine if there are loose bodies of cartilage or signs of inflammation or degenerative conditions such as osteoarthritis
   

End of procedure

Once the scan and any treatment are complete, your surgeon will remove the arthroscope and any other instruments. Your incisions may be closed with two or three non-dissolvable sutures and covered with small bandages, or they may be held closed with strips of surgical tape to close wounds.
They may give you a prescription for pain and tell you to apply ice to the area. Your doctor can also advise you on what to wear after hip arthroscopy, such as a brace and types of clothing to accommodate a brace. You may also need to walk on crutches or otherwise limit weight bearing on your leg for a period of time.
 

Hip arthroscopy recovery.

How long does the pain last after hip arthroscopy?

Symptoms often improve immediately after the procedure, but there may be a recurrence of some pain as the irritated joint lining heals, and there may be temporary tenderness in the hip and knee due to traction.
You may also feel a watery sensation on your hip or hear gurgling as a result of the fluid used during surgery, but it will quickly be absorbed by your body. The swelling should subside in about a week, and the sutures will usually be removed in seven to ten days. Your total recovery time may vary, depending on the specific treatment performed during your procedure.

Hip arthroscopy patients generally must use crutches for one to two weeks after surgery and receive six weeks of physical therapy. It can take three to six months before they are pain-free after physical activity.