Hip Arthroscopy & Hip Preservation Procedures

Hip arthroscopy is a relatively novel procedure which allows the surgeon to diagnose and treat hip disorders by providing a clear view of the inside of the hip with small incisions, using an instrument called an arthroscope. The arthroscope contains optic fibres that transmit an image of your hip through a small camera to a television monitor. This image allows the surgeon to thoroughly examine the inside of your hip and determine the cause of your hip symptoms. During the procedure, the surgeon also can insert surgical instruments through other small incisions around your hip to remove or repair damaged tissues.

If you have persistent hip pain or catching in your hip as a result of early hip osteoarthritis or a sporting injury, this procedure may allow repair of the soft tissue tear (“labral repair”), removal of loose bodies or debri, without opening up the hip joint. The procedure is performed in approximately 1.5- 2 hours, either as a day case or as an overnight procedure which is my preference to ensure appropriate physiotherapy input before and after the procedure. You will have a general or epidural anaesthetic and small (x2) cuts at the side of your hip.

HIP IMPINGEMENT AS A CAUSE OF HIP PAIN AND EARLY HIP ARTHRITIS

It is now recognised that many patients with early hip osteoarthritis has subtle anatomical abnormalities such as excess bone around the socket of the hip and/or hip head-neck region which can predispose a patient to early hip osteoarthrits (“Hip Impingement/”Femoroacetabular hip impingement”)

Hip arthroscopy is a technique which allows treatment of these subtle bony and soft tissue lesions and has been shown to improve patients symptoms. Advanced techniques allow reconstruction of the hip labrum if necessary in appropriate patients (“Labral reconstruction”). It is a highly technical procedure. It is important that your surgeon has an interest, appropriate training in this area and performs a large number of these procedures a year to maintain his or her skills in this area, building on operative experience to ensure the best possible outcome for the patient.

TIPS FOR A SUCCESSFUL OUTCOME

Patient selection for surgery or otherwise is key. It can be difficult to ascertain if the groin/hip pain you are experiencing is arising from the hip or if it is pain arising from stuctures adjacent to the hip joint, referred pain or due to a combination of causes. An experienced clinician working with physiotherapy and other medical colleagues (radiologist and general surgeon) ensures not just the most accurate diagnosis but ensures that the correct sequence of treatment is commenced.

As a general rule, the more severe the arthritic changes apparent in the hip radiologically, the less favourable the outcome from hip arthroscopy. It is important your expectations match that of your surgeons, otherwise you may not be happy with the outcome of your surgery. Make sure you understand and convey to your surgeon and the team your goals and expectations as these differ from patient to patient.

Hip arthroscopy frequently asked questions

Hip arthroscopy refers to keyhole operation of the hip. In this section I will briefly describe what a hip arthroscopy would involve. Patients with hip impingement, hip labral tears, soft and hard cartilage problems may benefit from hip arthroscopy.

What does a hip arthroscopy involve ?

Hip arthroscopy is a procedure which allows the surgeon to diagnose and treat hip disorders by providing a clear view of the inside of the hip with small incisions, using an instrument called an arthroscope.

The procedure is done under general and spinal anaesthetic. The arthroscope contains optic fibres that transmit an image of your hip through a small camera to a television monitor. This image allows the surgeon to thoroughly examine the inside of your hip and determine the cause of your hip symptoms. During the procedure, the surgeon also can insert surgical instruments through other small incisions around your hip to remove or repair damaged tissues.

How do you know if a patient needs hip arthroscopy

If you have groin/hip pain, and relevant imaging (x-rays/ MRI scans) confirm a cartilage tear (‘chondrolabral tear’) or loose bodies or a localised area of arthritis, and if you had a hip injection confirming the origin of your pain, you may benefit from hip arthroscopy.

Further options for treatment

Shaving bits of bone around the hip may be necessary to improve your symptoms during hip arthroscopy if you have hip impingement. If you have localised early arthritis, microfracture or stem cell like treatment may be an option.

What are the potential risks

  • Risks of hip arthroscopy include infection, nerve and vessel damage, clots (thrombosis), ongoing pain, persistent symptoms, a long recovery period, incomplete pain relief or progression of symptoms due to underlying arthritis of the hip.
  • Shaving bits of bone around the hip may be necessary to improve your symptoms during hip arthroscopy if you have hip impingement. If you have localised early arthritis, microfracture or stem cell like treatment may be an option.

What are your tips for a successful outcome

A secure diagnosis is key. This involves a thorough assessment clinically, xrays, MRI scan and a hip injection. Ensure you have a good physiotherapist and a period of rehab before and commit to rehab and exercises after surgery.