Hip Arthroscopy Improves a Variety of Conditions

November 7, 2012

Topic: Orthopaedics

Hip arthroscopy can be used to treat problems that cause pain and discomfort within the hip joint

In the field of orthopaedics, there are a variety of procedures that surgeons can perform to fix minor to severe ailments that affect the skeletal system. One popular surgical option is arthroscopy, which has evolved tremendously over the past three decades and can be used to diagnose and treat a variety bone and joint issues. Arthroscopy involves creating small incisions for the insertion of a small, thin camera and instruments into a joint. The camera allows the physician to view the joint, and the instruments can be used to treat problems inside the joint.

While arthroscopy has been used commonly in the knee and shoulder, this surgery has just recently advanced to become extremely useful in the hip. The hip joint is a ball-and-socket joint where the femoral head (ball) articulates with the acetabulum (socket). Subtle deformities and injuries of this ball and socket joint have recently become more widely recognized, and as a result, hip arthroscopy, or hip scopes, have flourished.

Why hip arthroscopy?

Hip arthroscopy can be used to treat problems that cause pain and discomfort within the hip joint. This includes treating the labrum, which is a cartilage-like structure around the acetabulum, the articular cartilage, which is the smooth covering over the end of the femoral head and acetabulum, and many other tissues that surround the hip joint. One of the most common issues that can be treated with arthrocopy is impingement syndrome, which is a risk factor for early arthritis and is being diagnosed by physicians more often.

Femur-acetabular impingement syndrome (often shortened as impingement syndrome or FAI) is a scenario where mild abnormalities in the shapes of the acetabulum and femoral head cause damage to the articular cartilage and acetabular labrum. As these tissues are damaged, pain develops at the hip joint, and the surrounding muscles begin to experience increased stress. There are two deformities that cause impingement: a bony prominence on the femoral head which is known as a CAM deformity and a bony shelf which extends from the acetabulum, which is known as a PINCER deformity. Typically, patients with impingement have a combination of both these deformities. Impingement syndrome can cause significant hip pain, limit functional ability, and lead to early degenerative arthritis of the hip. Hip arthroscopic techniques have been developed to remove the abnormalities causing impingement and treat the damages which impingement has created.

Other instances where an individual may need a hip scope include acetabular labral tears related to hip dysplasia, snapping hip syndrome, hip synovitis, loose bodies, or a hip joint infection.

How does it compare to a knee scope?

Like knee scopes, surgeons use an arthroscope (camera) for hip scopes, which requires two or three small incisions in the skin and creation of a path to the joint. Similar procedures are performed using this technique on both the shoulder, knee and ankle. However, there are some significant differences between hip arthroscopy and arthroscopy on other joints. For instance, following a knee scope, rehabilitation may only require a week of partial weight-bearing on the affected leg depending on how much the patient can tolerate and what was treated in the knee. With a hip scope, rehabilitation includes foot-touch weight bearing for four to six weeks, which means the patient can use their leg for balance but can not put full weight on the injured leg. In addition, following hip arthroscopy, patients have to follow a post-operative regimen, which restricts certain movements of the hip and requires extensive physical therapy and the use of a continuous passive motion machine. The differences in therapy and restrictions with hip arthroscopy are due to the importance of hip capsule healing after surgery which can affect hip joint stability.

Benefits and risks:

Like any surgical procedure, there is always a risk for complications. However, they are uncommon with hip arthroscopy. There is a small chance that an injury to the surrounding nerves, vessels or joint could occur due to the instruments. In addition, traction (pulling on the foot) is used to create a larger joint space during surgery. This can cause an injury to the nerves of the leg and groin, which could manifest as numbness. Nerve injury occurs in approximately five percent of hip arthroscopies and is typically temporary.

Despite these risks, many patients return to full, unrestricted physical activities after undergoing a hip scope. Moreover, the procedure can significantly reduce pain localized to the hip and decrease the risk of subsequent joint arthritis. Although return to physical activity is expected following surgery, an orthopaedic surgeon can advise patients on how to protect their hip joint after surgery. In certain cases, recommendations may include switching from high-impact exercise to lower-impact exercise to decrease the stress placed on the hip joint. In other cases, patients may expect a full return to their previous level of activity.

To learn more about hip scopes, or to make an appointment for a consultation, call 850.916.8700.

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