Hip Arthroscopy: Minimally Invasive Surgery of the Hip

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Christian T. Andersen, MDby Christian T. Andersen, MD

Advancements in arthroscopic procedures have allowed patients to undergo less invasive procedures with quicker recoveries. Orthopedic surgeons have used these procedures to manage stability and cartilage issues in the shoulder and knees for decades. Although slightly more complicated than the knee and the shoulder, arthroscopic procedures are now used to treat problems in the hip. This article will provide you with important information about hip arthroscopy.

Let’s start by defining exactly what arthroscopic surgery is. With arthroscopic surgery, the orthopedic surgeon uses instruments and a camera attached to small tubes that are about the thickness of a fountain pen. Instead of using incisions that are measured in inches, arthroscopic surgery only requires small quarter inch sized incisions that allow enough space for the passage of these instruments. Typically, a procedure will require three small incisions. Often, a saline solution is pressurized into the joint to allow for adequate visualization of the anatomy.

The hip is a relatively deep joint with a congruous ball and socket joint. In order to improve visibility of the hip, traction must be applied through a special table; creating a temporary space between the hip and the pelvis. The traction allows space for the operative instruments to fit within the joint. The table used for this procedure has been specifically designed for comfort and to reduce nerve compression during the procedure.

Other equipment used to facilitate hip arthroscopy includes fluoroscopy or x-ray images which help guide the instruments to the proper position in the joint. Also, the x-ray images help dictate exactly how much traction is needed to perform the procedure. Initially, the orthopedic surgeon will use specific surface topography or boney landmarks at the pelvis and the hip to decide where to make the small incisions.

Arthroscopic Surgery is used to treat a variety of issues in the hip. Here are some of the more common diagnoses that benefit from hip arthroscopy:

  • Snapping Hip Syndrome: There are occasions when the psoas muscle, one of the hip flexor muscles, can cause an audible snapping sound as it gets caught on part of the hip. This painful syndrome can be relieved through hip arthroscopy by releasing part of the muscle tendon.
  • Impingement Syndrome and CAM Lesions of the Hip: Frequent end range motions of the hip may result in excessive pressure or wear of the cartilage causing both pain and injury. Also, when the end of the thigh bone is not perfectly round, often referred to as a CAM Lesion, it can cause pinching of the labral or cartilaginous tissues resulting in excessive wear when the hip is at the extremes of flexion. Hip arthroscopy can be used to treat this.
  • Labral Tears of the Hip: The cartilage that surrounds the hip can tear or even become a loose body that painfully floats around the hip. Rather than feel the pain caused by a tear or experience the corrosive effects of a loose body, hip arthroscopy can provide relief. Some believe that hip arthroscopy can be used to delay hip replacement surgery by managing the labral issues caused by advancing arthritis.

The recovery from hip arthroscopy is much quicker than from conventional orthopedic surgery. Generally, patients can expect to be on crutches for a couple of weeks and back to driving in close to three weeks. Physical therapy is an important component of the recovery. How long to expect to be on crutches or in physical therapy will depend on how extensive the repair was within the hip.

If you would like to learn more about hip arthroscopy, please listen to the Podcast I recorded. If you have a problem with your hip, you may want to have it evaluated by a Board Certified Orthopedic Surgeon.