What is “hip arthroscopy” and is it right for me?
As with most things in medicine, an understanding of anatomy makes both problems and solutions a lot easier to understand. The hip is a ball and socket joint. The ball part is the upper end of the femur or thighbone and the socket is part of the pelvis called the acetabulum.
The end of each bone is covered in a shinny white material called cartilage, which acts as a shock absorber. There is another piece of cartilage that looks like a white gummy worm and wraps around the socket called the labrum. The labrum’s job is both to increase the surface area of the socket to allow for increased range of motion and also to help create a watertight seal, which assists in creating a stable joint.
There area also numerous muscles and tendons that cross the hip joint such as the iliopsoas (hip flexor), which crosses right in front of the hip joint. The gluteus medius and minimus (hip abductors), which are on the side of the hip and attach to the big bump on our side act to move the leg out to the side and prevent us from toppling over when we walk. There are also little fluid filled sacks called bursa, which act as cushions, one of which is found right over the bump on the side of the hip, and another one sitting right on the hip flexor.
So now that we understand the anatomy a little better, we can now answer the first question. A hip arthroscopy is an outpatient procedure where a camera and small instruments are inserted into the hip through two to four small incisions on the front and outer thigh. Each incision usually requires only 1 or 2 stiches. Recovery from a hip arthroscopy depends a lot on what is done and can vary greatly from person to person. Often patients are on crutches for 2-4 weeks and do physical therapy for at least two months. Full recovery from a hip arthroscopy can take anywhere from 6 months to a year. Despite being a minimally invasive outpatient procedure, quite a lot can actually be done.
Femoroacetabular Impingement and Labral Tears
This is by far the most common indication for hip arthroscopy today. The labrum can tear from either an acute injury, overuse, or due to a specific anatomical variation that causes excess bone or a bone spur on the femur (thighbone) to impinge pinch on excess on the acetabulum (hip socket) when the hip is flexed up. This last cause is called femoroacetabular impingement. If the labrum tears from an acute injury or overuse, it can simply be repaired back into place by anchoring it back to the socket. If the labrum tears due to femoroacetabular impingement, then the excess bone on the thigh bone or hip socket must be shaved down and moved in order to prevent the problem from recurring.
The absence of cartilage in a joint is called arthritis. Patients with complete loss of cartilage usually cannot be treated with arthroscopy and are usually best treated by joint replacement. However; the very early stages of arthritis sometimes manifest as small defects (like a pothole) in cartilage that can be addressed by various arthroscopic techniques.
Occasionally a piece of cartilage will break off and get trapped in the joint like a pebble. These can be removed arthroscopically.
Iliopsoas Tendon (Hipflexor) Problems
The hip flexor can be a nagging source of pain for some patients. Whether it is due to overuse, an acute injury, or even a mal positioned hip replacement, a chronic irritation of the hip flexor is sometimes treated by arthroscopically releasing it. This can sometimes lead to about 15% loss of power in hip flexion, which is why arthroscopic release is usually a last resort.
Abductor tears and bursitis
The muscles on the side of the hip and sometimes tear similar to the rotator cuff muscles in the shoulder. Partial tears can often be treated without surgery, but large full thickness tears sometimes require surgery to anchor the tendons of these muscles back down to bone. Sitting right on top of these muscles is a bursa called the trochanteric bursa. Trochanteric bursitis (inflammation or irritation of this bursa) can be a very difficult problem to treat and can be treated with excision of the bursa.