Due to the advances in fibre-optic and arthroscopic instruments as well as improved diagnosis through MRI, it is possible for orthopaedic surgeons to treat a variety of hip conditions arthroscopically. Arthroscopic (keyhole) surgery techniques, which have allowed surgeons to do accurate knee, shoulder, elbow, ankle and wrist surgery for many years without the need for large incisions, can now also be applied to the hip joint to diagnose and treat a variety of hip conditions.
The indications for hip arthroscopy are more limited and specific than for knee and shoulder arthroscopic surgery, but results are as successful for the right indications. Reasons for hip arthroscopy include:
Arthroscopic hip surgery is performed under general anaesthetic, and a traction table is needed to provide access to facilitate access to the hip's central compartment. X-ray control provides helpful information when resection of bony osteophytes needs to be done. With hip arthroscopy, labrum and bony hip conditions can be addressed accurately, with good outcomes. Only 1 night stay in hospital is usually required, and crutches are needed until symptoms have settled. There are different approaches for arthroscopic hip surgery; however, Dr Morkel prefers this one in particular.
The outside-in technique which reduces traction and overall surgical time, provides better visualisation and can be done with ordinary arthroscopy instruments. It is therefore the preferred approach for Dr Morkel.
While the risk of developing deep vein thrombosis (DVT) after arthroscopic (keyhole) surgery is low, there is always a risk of deep vein thrombosis (DVT) with all lower limb procedures, especially hip procedures. Deep vein thrombosis (DVT) can be prevented by:
- Identifying high-risk patients
- Limiting the period of inactivity (the time before and after the procedure that the patient stays in bed)
- Good hydration
- Specific physiotherapy exercises and mechanical foot pumps
- Pharmacological preventative treatment (when needed)
The risk of developing deep vein thrombosis (DVT) is also increased in longer procedures with longer traction time; however, the new outside-in technique reduces traction time and the overall surgical time. If deep vein thrombosis (DVT) does appear, early treatment is key.
The risk of infection with all arthroscopic procedures is very low, but if soft tissue infection occurs, it can easily be treated.
There is a risk of nerve injuries whenever traction is needed to facilitate exposure of the hip joint. The new outside-in technique that Dr Morkel uses for hip arthroscopy however diminishes traction time and the risk of nerve injuries. In the case that nerve injuries are sustained due to traction, they are usually reversible (neurapraxia).
Can osteoarthritis of the hip be treated by arthroscopy? Once the chondral cartilage has begun to deteriorate, the results of arthroscopic surgery aren't good. MRI scans can help determine the amount of chondral damage prior to surgery to see if this approach may work or not. If the joint space on x-rays is narrowed to less than 3 mm, the arthroscopic technique is not favourable
Because the results of curettage and bone grafting of osteochondral cysts in the hip using arthroscopic techniques aren't good, Dr Morkel would advise against it.
In some cases, the femoral head, which is the ball of the hip joint, can develop an extra bone. This extra bone creates an abnormal ball for the hip joint, looking like a pistol grip. This is called a cam lesion, which can limit the range of motion of the hip joint. In some cases, the acetabulum, the socket into which the ball fits to make the hip joint, can develop a bony rim which is called a pincer lesion. This can become impinged and limit the range of motion of the hip joint. As long as the chondral cartilage is still unaffected, these bony protuberances can be safely removed by Dr Morkel to improve range of motion and enhance activities of daily living.