Hip Arthroscopy – How It Works and Why It’s Necessary

Apr 20, 2021 | Articles

The suffixes “-scope” and “-scopy” repeatedly occur in medical terminology and refer, respectively, to a specially designed optical instrument and its use to conduct an internal examination on some part of the body. In many cases, the device can be introduced through a natural opening in the body, such as the oesophagus, trachea or urethra. However, in the case of hip arthroscopy, there is no natural access to the interior of this or any other joint. It is, therefore, necessary to make a small surgical incision through which to insert the scope.

Each of the instruments used for these internal exploratory examinations consists of a tube fitted with a light source and a miniature video camera. The light is directed to the examination area by a fibre optic cable which also conveys the view of the illuminated area back to the camera. A flexible tube is essential to navigate the oesophagus or colon, whereas hip arthroscopy employs a rigid tube. The video camera feed can be recorded and relayed live to a monitor where it provides the surgical team with a high-definition, full-colour, magnified view of the joint and surrounding soft tissues.

The examination is usually undertaken on an outpatient basis, and the subject is given a local anaesthetic. On occasion, however, a general anaesthetic may be the option of choice. To insert the scope into the joint, the surgeon must first dislocate it. To ensure the joint remains distracted until the hip arthroscopy is complete, the specialist must then inject fluid or air. At this point, it is now possible to introduce the scope and begin exploring the joint for any evidence of damage or disease. So why might a patient find it necessary to undergo this type of examination?

Typically, these patients report to their general practitioner complaining of pain in the hip or groin. The discomfort may be accompanied by stiffness and restricted mobility, or a sensation of catching or clicking during movement. However, before referring them for hip arthroscopy, the GP will generally first treat the symptoms with pain killers or cortisone injections and continue to do so for as long as these medications continue to be effective. At this point, the next step will be a referral to an orthopaedic specialist who will probably begin with a physical examination followed by some preliminary X-rays and medical imaging of the troublesome joint.

In the past, the only way for the specialist to get a closer look at the problem would have been to perform open surgery. By contrast, hip arthroscopy is a minimally invasive procedure that serves both as an invaluable aid to diagnosis and, where practical, a markedly less radical alternative to open joint surgery. It is not hard to understand how the latter possibility has revolutionised joint surgery. After all, why would a surgeon choose to expose a patient to two separate procedures if it may be possible to perform the diagnostic examination and the surgical intervention during the same session?

Performing the necessary intervention during hip arthroscopy also offers several other significant benefits. Depending on the purpose of the procedure, between two and four incisions of just five to ten millimetres in length are all that is necessary. Compare this with the need to expose the joint fully during the conventional approach. The arthroscopic technique means there is less risk of excessive bleeding or infection, and post-operative recovery is quicker.

Typical of the conditions commonly diagnosed and treated using this minimally invasive technique are osteoarthritis, torn labrum, femoroacetabular impingement, and hip dysplasia. These and similar procedures are among the hip arthroscopy services undertaken by a locally and internationally renowned team of orthopaedic specialists at the Wilgers Life Hospital in Pretoria.