Arthroscopy is being used more and more for treatment of a painful hip. While arthroscopic procedures are most commonly done in the knee, shoulder and elbow, more surgeons are gaining experience with arthroscopy of the hip.
Arthroscopy is a technique that uses a fiberoptic scope and small instruments to perform surgery on a joint. The scope and instruments are inserted through three or four tiny incisions called portals. A light source and a television camera are connected to the arthroscope. The surgeon then views the inside of the hip joint on a television monitor as he uses his instruments to do the procedure.
The procedure is done under general anesthesia. Most often the patient is lying on his side with the operative side facing up towards the surgeon. This is called the lateral decubitus position. The procedure can also be performed with the patient lying flat or supine. Traction is applied to the leg to separate the joint surfaces and create a wider space to place the arthroscope and instruments.
Arthroscopy may be used as both a diagnostic and therapeutic procedure in the hip. It can be used to evaluate the cause of a painful hip when plain x-rays and MRI have been negative. It may identify a problem causing mechanical symptoms such as clicking, snapping, or catching in the joint. Surgery can then be done to treat the problem under arthroscopic control.
Some of the problems treated by hip arthroscopy include removal of free fragments of bone or cartilage called loose bodies and removal of arthritic bone spurs called osteophytes. The osteophytes may impinge on the edge of the joint and cause mechanical symptoms.
In one condition, synovial chondromatosis, multiple loose bodies form from articular cartilage. These can-not be seen on a plain x-ray and sometimes are not completely visible on MRI. The loose bodies cause pain and catching within the joint.
In the past, treatment of synovial chondromatosis of the hip was by an open incision or arthrotomy. Now the procedure can be done with much less trauma arthroscopically.
A tear of the ligament surrounding the hip joint, the acetabular labrum, can sometimes be repaired arthroscopically. If the labrum breaks off and tears, the loose fragment may cause pain, catching, and mechanical clunking within the joint. This fragment may be removed arthroscopically or sutured back in place by advanced techniques.
Arthroscopy may diagnose an early case of osteoarthritis even though other studies are negative. Scuffing or dam-age to the articular surface seen through an arthroscope may be the cause of pain in the groin and thigh. In more advanced cases, a shaving or smoothing of the painful joint surfaces called an arthroscopic debridement or chondroplasty may be done. The long-term benefits of this type of procedure, however, are not clear.
Arthroscopy may be helpful in assessing the joint surface in a hip with avascular necrosis. Some surgical procedures for the treatment of AVN require that the joint surface be smooth and intact. These are procedures such as core decompression or bone grafting that are normally done before the femoral joint surface col-lapses. If the joint surface is collapsed then the treatment would be arthroplasty or replacement. In this situation, arthroscopy can be used to determine the status of the joint and whether or not a joint preserving procedure will be effective.
Finally, arthroscopy can be useful as a diagnostic procedure in a painful or infected total hip. An arthroscopic drainage can be done if the joint is infected. Arthroscopy is done as an outpatient surgical procedure under general anesthesia. Most patients will be on crutches for a period of time to protect the joint after surgery. Sutures are removed 7 to 10 days postop-eratively. The physical therapy and rehabilitation pro-gram is determined by the operating surgeon based upon the findings. It may be several months before a patient is able to return to sports.
Known complications of arthroscopy include bruising or injury to the articular surface by the scope and temporary nerve palsy resulting from traction applied during surgery. Most complications are temporary and resolve quickly with treatment.
Arthroscopy is evolving as a technique. More surgeons are learning to do the procedure and better instruments are being developed. It is likely that arthroscopy will play a greater role in the future in the diagnosis and treatment of a painful hip.