Historians have traced the earliest attempts to view the internal workings of a living human body to the Roman physician, Galen (aka Aelius Galenus or Claudius Galenus), who first used a speculum to examine the rectal cavity. Progress in this field, however, only began in earnest with the arrival of the first functional endoscope during the late 18th-century. Since then, successive advances have produced similar instruments for most surgical fields, including orthopaedics, where hip arthroscopy is now an invaluable routine procedure.
The procedure involves inserting a specially designed optical instrument into the hip joint via a tiny keyhole incision. The modern arthroscope consists of a hollow tube containing lenses and a fibre-optic cable. The latter serves to conduct the light necessary to illuminate the examination area and relays a view of the joint’s interior to a miniature video camera. The captured images are then displayed on a monitor screen to provide the surgical team with a high-definition, magnified view of the joint’s interior.
While the original role of hip arthroscopy was strictly that of a valuable new diagnostic tool, this is no longer the case. Almost half of appendectomies performed today are conducted with the aid of a laparoscope. Likewise, wherever possible, many orthopaedic surgeons now employ an arthroscope to perform minimally invasive interventions rather than exposing their patients to the risks associated with open surgery.
The Procedure
Trauma to the joint is minimal, so surgeons generally undertake arthroscopic examinations on an outpatient basis, under either general or local anaesthesia. The significantly shorter recovery period allows most patients to return home soon after their hip arthroscopy. The surgeon first applies traction to the leg, which opens the joint sufficiently to provide access for the scope. Guided by a portable X-ray machine, they then insert a hollow needle into the joint and inject a sterile fluid to keep it open.
The next step is to pass a guidewire through the needle, which is then removed and replaced with a cannula, through which the flexible arthroscope can then inserted more easily. By adjusting the scope’s position during hip arthroscopy, the surgeon can perform a detailed inspection of the femoral head, the acetabulum and the surrounding soft tissues. Where damage or disease is found or already known to be present, the surgeon can proceed directly from a confirmatory inspection to perform the appropriate remedial intervention.
Typical Applications for the Procedure
In suitably skilled and experienced hands, the arthroscope can also offer a means to perform numerous therapeutic interventions that would previously have required open surgery and the associated risks of excessive bleeding and infection, not to mention lengthy recovery times. For surgeons familiar with the necessary techniques, hip arthroscopy has become the option of choice when treating many patients. Numerous orthopaedic interventions are now frequently performed arthroscopically. These include repairs to labral and meniscal tears and damaged ligaments, trimming and smoothing the bony spurs responsible for femoroacetabular impingement (FAI), and the treatment of synovitis and joint infections.
These and other arthroscopic procedures involving the hips, knees and shoulders are available from a team of highly skilled and experienced orthopaedic specialists at the Wilgers Life Hospital in Pretoria. The centre has become an internationally renowned destination for patients requiring hip arthroscopy.