Hip Arthroscopy Procedure
Anatomy of the Hip Joint
The hip joint is a “ball and socket” joint located where the thigh bone (femur) meets the pelvic bone. The upper segment (“head”) of the femur is a round ball that fits inside the cavity in the pelvic bone that forms the socket, also known as the acetabulum. The ball is normally held in the socket by very powerful ligaments that form a complete sleeve around the joint capsule. Both the ball and socket are covered with a layer of smooth cartilage, each about 1/8 inches thick. The cartilage acts as a sponge to cushion the joint, allowing the bones to slide against each other with very little friction. Additionally, the depth of the acetabulum (socket) is increased by a fibrocartilaginous rim called a labrum that lines the rim of the socket and grips the head of the femur, securing it in the joint. The labrum acts as an “o-ring” or a gasket to ensure the ball fits into the socket.
What Conditions can be Treated with Hip Arthroscopy?
Femoral Acetabular Impingement or FAI is a condition of too much friction in the hip joint. Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint. The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket).
Labral Tear: The labrum of the hip is a cuff of thick tissue that surround the hip socket. The labrum helps to support the hip joint. When a labral tear of the hip occurs, a piece of this tissue can become pinched in the joint causing pain and catching sensations.
Loose Bodies: Loose bodies are pieces of cartilage that form within the joint. They look like small marbles floating within the joint space. These loose bodies can become caught within the hip during movements.
Snapping Hip Syndrome: Snapping hip syndrome has several causes, some of which can be treated with hip arthroscopy. If something is catching within the hip joint, hip arthroscopy can be used to relieve this snapping. Also, hip arthroscopy can be used to perform a psoas tendon release in cases of internal snapping hip syndrome.
Cartilage Damage: In patients with focal cartilage damage, meaning not widespread arthritis, hip arthroscopy may be helpful. These patients may sustain an injury causing a piece of cartilage to break away from the surface of the bone. These patients may benefit from removal of that piece of cartilage.
Early Arthritis: This is a controversial topic, as patients who have arthritis pain generally will not benefit from a hip arthroscopy. The patients who tend to benefit have specific finding of impingement (pinching) within the hip joint, and may benefit from removal of the bone spurs causing this impingement. This is only possible in the very early stages of arthritis, and even then may not offer relief of symptoms.
What Happens During a Hip Arthroscopy?
Hip arthroscopy, or a “hip scope,” is a minimally-invasive procedure. The use of an arthroscope means that the procedure is done using 2 – 3 small incisions (approximately 1/4 – 1/2 inch long) rather than a more invasive “open” surgery that would require a much larger incision. These small incisions, or “portals”, are used to insert the surgical instruments into the joint.
Aiding other advances in arthroscope technology, the flow of saline through the joint during the procedure provides the surgeon with excellent visualization. The surgeon is also aided by fluoroscopy, a portable x-ray apparatus that is used during the surgery to ensure that the instruments and arthroscope are inserted properly.
The instruments include an arthroscope, which is a long thin camera that allows the surgeon to view the inside of the joint, and a variety of “shavers” that allow the surgeon to cut away (debride) the frayed cartilage or labrum that is causing the pain. The shaver is also used to shave away the bump(s) of bone that are responsible for the cartilage or labral damage.
In addition to removing frayed tissue and loose bodies within the joint, occasionally holes may be drilled into patches of bare bone where the cartilage has been lost. This technique is called “microfracture” and promotes the formation of new cartilage where it has been lost.
The procedure is normally done as an “outpatient” surgery, which means the patient has the surgery in the morning and can go home that same day. Normally, the patient is under regional anesthesia (the patient is numbed only from the waist down) and does not require a breathing tube.
What is the Recovery Time Associated with Hip Arthroscopy?
Following the procedure, patients are normally given crutches to use for the first 1 – 2 weeks to minimize weight-bearing. A post-operative appointment is normally held a week after the surgery to remove sutures. Following this appointment, the patient normally begins a physical therapy regimen that improves strength and flexibility in the hip.
After six weeks of physical therapy, many patients can resume normal activities, but it may take 3 – 6 months for one to experience no soreness or pain following physical activity. As no two patients are the same, regular post-operative appointments with one’s surgeon is necessary to formulate the best possible recovery plan.
What is the Benefit of Hip Arthroscopy Compared to Open Surgery?
The nice part about hip arthroscopy is that it is much less invasive than traditional hip surgery. This means:
- Early rehab
- Accelerated rehab course
- Outpatient procedure
- Smaller incisions
- Quicker return to active lifestyle