Advances in Fibre-optic instruments and arthroscopic instruments, combined with improved diagnosis through MRI, have made it possible for surgeons to treat a variety of hip conditions arthroscopically. Arthroscopic (keyhole) techniques, which have allowed surgeons to do accurate knee, shoulder, elbow, and ankle and wrist surgery for many years, can for the past 15 years be applied to hip pathology too.
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. Indications for hip arthroscopy:
The procedure 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 provide helpful information when resection of bony osteophytes needs to be done. Only 1 night stay in hospital is usually required and cruthes is needed until symptoms have settled.
Advances in hip arthroscopy of the past 15 years and made it possible to improve patient’s lives with a minimally invasive procedures. Labrum and bony hip pathology can be addressed accurately, with good outcomes, whilst experiences with hip arthroscopy over the past 15 years have also narrowed down those conditions which do not do well with hip arthroscopies. A further development from prominent surgeons, in the United States and Europe, is the outside in technique which reduces traction and overall surgical time, provides better visualisation and can be done with ordinary arthroscopy instruments.
The risk is low with Arthroscopic (keyhole) surgery, although there is always a risk of DVT’s with all lower limb procedures, especially hip procedures. DVTs must be prevented by, identifying the high risk patients, limit the period of inactivity (the time before and after the procedure that the patient stays in bed), good hydration, specific exercises, mechanical foot pumps and if needed pharmacological preventative treatment can be used. The risk of DVTs are also increased with longer procedures and traction time. The new outside-in technique reduces traction time and the overall surgical time. Early recognition is important to limit harm if DVT’s do occur.
The risk with the infections, as with all arthroscopy procedures, is very low. Like any soft tissue infection can easily be treated
There is a risk of nerve injuries whenever traction is needed to facilitate exposure. Nerve injuries sustained due to traction are usually reversible (neurapraxia). There is a higher with longer traction and therefore the new outside-in technique, that we use, diminishes traction time and the risk of nerve injuries.
Once the chondral cartilage and have started to deteriorate, the results with arthroscopy is not good. I resolution MRI scans can determine the amount of chondral damage. Once the joint space on x-rays is narrowed to less than 3 mm then the results of arthroscopy is not favourable.
The results of curettage and bone grafting of osteochondral cysts in hips are not not good.
Some patient’s femoral heads (the ball of the hip joint) develop extra bone that forms a type of abnormal form of head and neck (looks like pistol grip) that can limit range of motion. On the acetabulum (socket) side a bony rim (pincer) lesion can also impinge and limit range of motion. As long as the chondral cartilage still unaffected, these bony protuberances can be safely removed to improve range of motion and enhance activities of daily living.