Overview of Hip Arthroscopy

First developed in 1931, hip arthroscopy of the hip has had a slower evolution than that of the knee, due to the difficulty of using the straight arthroscope (camera) within spherical hip joint. However, specialist instruments have been forthcoming in the last few years to aid the procedure and allow useful therapeutic interventions to take place.

So when can hip arthroscopy be useful, and which conditions can it help?

Symptomatic hip disease from the following:

• Tears of the Acetabular Labrum (cartilage lip around the cup) 
• Impingement lesions (CAM or Pincer) of the femoral neck and/ or acetabulum. (bony lumps around either side of the hip)
• Tendon snapping
• Localised cartilage damage
• Trochanteric bursitis (pain on the outside of the hip, often restricting ability to lie on one’s side)

With modern equipment and techniques, we can repair or resect torn labrum, burr away femoral neck bumps, recess acetabular overhang (Pincer lesions), remove loose and (occasionally foreign- bullets!) bodies.

Occasionally, arthroscopy can be useful in the hip where diagnosis is a problem despite traditional investigations.

Investigations

Often a patient’s history will give us clues as to the diagnosis. For instance, pain on prolonged driving, pain associated with certain sporting activities can suggest labral tears, impingement lesions or both.

Examination can help to confirm, and X-rays can be diagnostic for bony lesions, and help exclude arthritis as a cause.

The gold standard investigation however remains the Gadolinium enhanced MRI scan. This very clearly shows the soft tissue structures around the hip, and can in addition inform us about the more unusual diagnoses such as inflammatory arthropathy, and avascular necrosis.

The Procedure

You will be assessed carefully in the outpatient department, and once the diagnosis is clear and as long as hip arthroscopy offers a surgical solution, then an operation date will be arranged. Pre-assessment will take place shortly before surgery to determine your general medical health, and you will be admitted often on the day of surgery.

Your stay in hospital will either be a single day, or more commonly, overnight. General anaesthesia is used, as we need you to be fully muscle-relaxed to allow a satisfactory view inside the hip.

The arthroscope is introduced through one of commonly 2, rarely 3, portals, each measuring around 1-2cm. These are located on the side and just to the front of your greater trochanter (the prominent bone on the outside of the hip).

We have a careful look throughout the hip joint, and if suitable for treatment, then thin, guided instruments are introduced to allow removal, release or fixation of tissues.

Occasionally, if a lesion is in a difficult-to-access area within the hip, or is just too large to be addressed by the arthroscopic method, then a small wound may be made on the front of the hip to allow a limited ‘open’ procedure to take place and achieve the desired result.

Local anaesthetic is instilled as we leave the hip joint, and small sutures will close the wounds.

Post Operatively

The patient is mobilised later the same day, soreness allowing, and often uses crutches for 1-2 weeks to allow the wounds to settle and heal.

Intensive physiotherapy and personal exercises are important to regain early hip movement, and to prevent scarring from restricting motion. Recovery to sporting activities is usually around 8-12 weeks, but depending on the amount of treatment required within the hip, may be as long as 6 months. Occasionally we discover damage within the hip that is just not treatable by ‘conservative’ means, and other methods such as hip replacement options may need to be discussed at a later date.

Hip Arthroscopy Complications

These are reasonably rare, but include sensory loss on the outer thigh, infection, and thrombosis. Failure to improve can also be a problem, but the chance of positive outcome varies with each individual case and diagnosis, so we will chat to each patient about their individual likely outcome.

Talk to us about Hip Arthroscopy

To talk about hip arthroscopy treatment please get in touch using our contact and appointments page.