There is a surgical procedure that can be used to diagnose, visualize, and treat injuries and problems that are found inside any given joint. This procedure is known as arthroscopy and involves cutting into the skin to make a small incision so that a small, pencil-sized camera can be pushed into a damaged or injured joint so that a doctor can see it better. Getting this magnified look at the injury will help a doctor more accurately diagnose and treat it.
There are many benefits to arthroscopy, which include fewer complications, lower risks, shorter recovery time, less pain after the surgery, and much less scarring. It is almost always considered an outpatient surgery. It’s a minimally invasive procedure that allows the doctor to work through a variety of different hip procedures, including cartilage restoration, labral repair, treatment of FAI (Femoral-Acetabular-Impingement), and loose body excision.
Though it is not as common as shoulder or knee arthroscopy, hip arthroscopy has been practiced for many years.
The structures of your hip are exposed in great detail during hip arthroscopy, which gives your orthopedic surgeon a better idea of what they are working with. Torn cartilage is repaired through the use of small instruments during this procedure.
ANATOMY
If you look at the anatomy of the hip, you’ll see that it’s a joint that is made up of two parts; the ball and its socket. The acetabulum is part of the pelvis bone and forms the socket. The upper end of the high bone is called the femoral head and creates the ball.
There is articular cartilage that coats both parts of the ball and socket. It’s a slippery tissue that creates a nearly frictionless, smooth surface that allows the two bones to function properly while gliding across each other.
There is a strong fibrocartilage that rings around the acetabulum that is known as the labrum. It creates a gasket around the socket.
There are a variety of band-shaped tissues that surround the joint. These are called ligaments. Basically, they hold the joint together. There is also a thin membrane that covers the underside of the capsule that is known as synovium. It lubricates the hip joint by producing synovial fluid.
The femoral head will fit snugly into the acetabulum on a healthy hip.
WHEN HIP ARTHROSCOPY IS RECOMMENDED
Nonsurgical treatment is always the first option. Examples of nonsurgical treatment include physical therapy, rest, injections, and medication that can be taken in order to reduce inflammation. If these treatments fail, then hip arthroscopy may be the next recommended step.
Many painful symptoms that are caused by damage to the articular cartilage, labrum, or other soft tissues that surround the joint can be relieved through hip arthroscopy. Though one of the more common reasons for this damage is injury, orthopedics has uncovered other conditions that can lead to these problems.
- Femoroacetabular impingement (FAI) is a condition that causes the bone spurs around the femoral head to create damage.
- Dysplasia is a condition that makes the socket abnormally small which will make the labrum vulnerable to tearing.
- Snapping hip syndromes causes a popping or snapping sound that is usually harmless. More often than not, this condition doesn’t require treatment and is caused be a tendon rubbing across the outside of the joint. There are some cases where the rubbing is damaging.
- Synovitis inflames the tissues around the joint.
- Loose bodies are caused by pieces of cartilage or bone that get knocked out of their normal placement and move around inside of the joint.
SURGICAL PROCEDURE
The first step of the operation is an evaluation performed by the anesthesia team. The most common procedure for hip arthroscopy is the use of general anesthesia, which will put the patient to sleep for the duration of the operation. Another possibility is regional anesthesia, which can come in the form of an epidural or spinal injection. This form of anesthesia will numb the body from the waist down while keeping the patient awake. Your anesthesiologist and orthopedic surgeon will converse with you so that you know which method will be best for you. The duration of the procedure depends on what the hip surgeon finds during the operation and how much there is to be corrected.
Before the procedure begins, the hip will be pulled away from the socket so that there is space for your surgeon to insert instruments while still having visuals and access to the entire joint. This is known as putting your leg in traction.
After the hip is pulled and traction is applied, a small hole will be made in your hip that’s about the size of a button hole. The arthroscope will go through there, and that will allow your surgeon to look at the inside of your hip so that he can figure out what the damage is.
Once the problem has been identified, the surgeon will then create separate incisions in order to insert other instruments that will be used to treat the problem. There is a wide variety of different procedures that may be done; the one used will depend on the personal needs for the injury. Some examples of problems that can be solved with arthroscopy include trimming bone spurs caused by FAI, smoothing away the torn cartilage or repairing it, and removing inflamed synovial tissue.
COMPLICATIONS
It is very uncommon to experience any complications as a result of hip arthroscopy, but there is a small risk of damage to the surrounding vessels and nerves that comes with any hip joint surgery. The traction technique that is used to prepare the hip for surgery can cause numbness and stretch the nerves, but both of those are temporary.
There is also a chance that the damage to the hip is too severe to be reversed by this procedure, which will render the arthroscopy unsuccessful. Another small risk is infection or blood clots that form in the legs (deep vein thrombosis).
RECOVERY
Post-surgery procedure allows the patient to remain in the recovery room for around two to three hours before they are allowed to be discharged and sent home. The patient will need to have someone drive them home and then spend the first night after the surgery with them. Another post-surgery expectation involves crutches or a walker for some time while the hip heals.
REHABILITATION
After the surgery is complete, the responsible surgeon will create a rehabilitation plan that will reflect the surgical procedures. Crutches are a necessary accessory for some, but they shouldn’t be needed once any limping has ceased. The more extensive procedures may require crutches afterwards for anywhere between one to two months.
Physical therapy may be needed in order to reach the best recovery after the surgery. There are specific exercises that can be used in order to restore mobility and strength. Additionally, the physical therapist can guide the patient through a list of “do’s and don’ts” that should be observed after hip arthroscopy surgery.
