Today, orthopaedic specialists regularly employ hip arthroscopy to perform surgery. However, theirs was the last medical discipline to enjoy the many benefits made possible when armed with an endoscope. The latter is a generic term that describes any instrument used to examine the interior of bodily orifices such as the colon, bladder, oesophagus, and trachea. While the finer details may vary according to their purpose, modern endoscopes generally include a source of illumination and a miniature video camera which, together, provide the surgeon with a real-time, full-colour, detailed view of the area under examination.
Like laparoscopy, hip arthroscopy for surgery or diagnostic purposes differs from most other commonly performed endoscopic procedures. When examining the interior of a joint or the abdominal cavity, the instrument must be inserted via a surgical incision rather than through one of the body’s natural openings such as the mouth, urethra, or anus.
The big breakthrough for orthopaedics came in 1918 when a Tokyo Professor named Kenji Takagi modified a cystoscope, an instrument designed for bladder examinations, and inserted it into a knee joint. However, it was more than half a century before hip arthroscopy was first used to perform surgery. This advance was also the work of a Japanese surgeon. It was Doctor Masaki Watanabe who, on the 4th of May 1962, employed an arthroscope and some miniature instruments to perform a meniscectomy. His patient was a 17-year old male who had twisted his knee during a basketball game. Previously, this procedure would have required the attending surgeon to expose the entire joint, thereby increasing the risk of excessive bleeding and infection and adding to the patient’s recovery time.
While the potential use of arthroscopy for hip surgery had been proposed and outlined way back in 1931, it was a further 60 years before it would become a widely-accepted procedure. Since those pioneering days, there have been vast improvements in the design of arthroscopes and the surgical techniques developed for use with them. Where the early instruments required the surgeon to peer through an eyepiece and to rely on gaslight or filament bulbs for illumination, today’s arthroscopes utilise fibre optics with powerful LEDs and transmit high definition video images to a conveniently-positioned monitor.
However, technological advances aside, hip arthroscopy surgery requires exceptional skills and considerable experience on the part of the surgeons who choose to practice this minimally invasive alternative methodology. Subsequent years have also seen surgeons exploring new possibilities, and so the list of procedures now performed in this fashion has grown considerably.
Extending the role of the arthroscope from that of a diagnostic tool to a surgical aid has meant the instruments used need to be smaller. Typically, surgeons must make two or three additional keyhole incisions to provide access. Naturally, the surgeon has far less space in which to manipulate these instruments than when performing an open procedure. Nevertheless, the use of hip arthroscopy to perform surgery has continued to grow, and many orthopaedic surgeons are now choosing to specialise in this challenging but equally rewarding field.
Frequently, damage or disease within the femoroacetabular joint or its associated soft tissues can be a source of intense pain and, if left untreated, may begin to compromise a patient’s mobility. Often, such problems can be treated surgically, and, in many cases, it is possible to perform the intervention arthroscopically. For example, arthroscopic procedures are now used routinely to repair an acetabular labral tear, to flush bone and cartilage fragments from the joint and to treat septic arthritis. Opting for this minimally invasive approach will often permit surgeons to discharge their patients on the same day.
Hip arthroscopy surgery is a speciality of the orthopaedic at the Life Wilgers Hospital in Pretoria; now a popular referral destination for patients from South Africa and several overseas countries.