#treatment - Hip

Hip Arthroscopy

  • Hip arthroscopy means keyhole surgery of the hip joint
  • Under an anaesthetic, a camera on the end of a telescope can be passed into the hip joint
  • The inside of the hip can be visualised, helping confirm a diagnosis
  • Damage inside the hip, such as loose bits of cartilage or cartilage tears can be treated

The hip joint is the largest ball and socket joint in the body and goes through seven million movement cycles per year in the average person. The hip joint can be prone to wear and tear and arthritis in older individuals. However, younger people can also develop a variety of hip joint problems that can affect walking, running, sport and daily activities.

Advances in technology and an increased awareness of pathology have allowed us to investigate and image problems of the hip joint with a new degree of accuracy. Scans such as MRI-arthrograms can show tears of the cartilage within the hip joint clearly.

The word ‘arthroscopy’ means literally ‘looking into the joint’. Knee arthroscopy was first introduced into the UK in the 1970s and is now one of the most commonly performed orthopaedic operations. Arthroscopy of the hip joint is a much newer procedure due to the added technical complexities, and is currently only being performed by relatively few orthopaedic surgeons.

Problems in the hip joint that can potentially be treated by arthroscopic surgery of the hip include:

  • Loose bodies (loose bits of cartilage floating around inside the joint)
  • Labral tears (tears of the rim of cartilage surrounding the socket)
  • Chondral damage (wear and tear of the layer of cartilage covering the bone)
  • Femoro-acetabular impingement (extra lumps of bone catching and rubbing in the joint)

There is a wide variety of different symptoms that these pathologies in the hip joint may cause, including:

  • Pain in the hip (often felt in the groin)
  • Clicking within the joint
  • Giving way (where the leg just ‘gives out’)
  • Discomfort when moving the hip into certain positions (especially lifting the knee up and rotating the leg inwards)
  • Stiffness of the joint
  • Difficulty walking or running

Traditional open surgery of the hip joint is a major procedure and involves large cuts through the skin and the muscles to get to the joint. Arthroscopy of the hip, however, allows the joint to be visualized with tiny telescopes and cameras and for pathology within the joint to be treated with specialized probes, through tiny skin incisions with minimal damage to the tissues.

Hip arthroscopy is performed under a general anaesthetic. The patient’s leg is strapped into a traction table that gives distraction of the hip joint, pulling the joint open in order to allow the passage of the arthroscope (a small rigid telescope with a digital camera on the end) into the space between the ball (femoral head) and socket (acetabulum) of the joint. Small probes and other specialised instruments that can be introduced into the hip joint to allow a wide variety of different surgical procedures to be performed.

Diagram showing how a telescope is inserted into the hip joint (inset picture shows an X-ray view of the telecope and a probe in the hip joint).

Intra-operative picture showing a hip arthroscope inserted into a hip joint.

Intra-operative picture showing a hip arthroscope inserted into a hip joint.

 Intra-operative arthroscopy picture showing two loose pieces of cartilage within a hip joint just before they are surgically removed.

Intra-operative arthroscopy picture showing two loose pieces of cartilage within a hip joint just before they are surgically removed.

 

Patients are kept in hospital overnight, after hip arthroscopy surgery, but are normally able to go home the following day. Post-op, patients are normally allowed to partially weight bear, with the help of a crutch. However, after hip arthroscopy you are normally advised not to run or do sport for at least 6 weeks, to allow the joint to recover from the operation first. If more major pathology is found within the hip joint and more major procedures are performed, then sometime it is necessary to protect the joint by resting it and avoiding running for up to 3 months.

If you have a hip arthroscopy then your surgeon will advise you of exactly what they found inside your hip, what was done, and therefore what rehab will be necessary for you individually.