Indications for Hip Arthroscopy and Its Use in Keyhole Surgery
One of the many reasons a surgeon may wish to perform hip arthroscopy, irrespective of whether this is followed by some form of surgery, is as a means to explore the joint in greater detail than is possible when relying solely upon X-ray images. Typically, it is a procedure undertaken for diagnostic purposes when investigating cases of unexplained joint pain. The procedure involves the use of a thin, tubular device, similar to an endoscope, that is inserted through a small incision into the joint. A miniature camera located in its tip relays video images of the bones and surrounding tissues to an eyepiece or a monitor screen, providing the surgeon with details of any inflammation or damage that might indicate a possible need for surgical intervention.
It quickly became apparent that arthroscopy applied to the hip and other joints could, in many cases, be combined with surgery, in order to treat a number of common problems directly. The move has led to a significant reduction in recovery time and risk of infection, as the use of an arthroscopic procedure can often circumvent the need to adopt the more radical, traditional approach in which the surgeon must expose the entire joint.
There are a number of common indications for the use of hip arthroscopy as the preferred means to perform keyhole surgery. These include irrigation of the joint to remove any loose particles of bone or foreign bodies present, to undertake the repair of damaged cartilage, to manage infections and inflammation, and to carry out repairs to a torn ligament. The two most common reasons for conducting these procedures, however, are either to repair or remove a torn labrum or as a means to correct the condition known as femoroacetabular impingement or FAI.
An acetabular labral tear is a common form of damage that affects a band of cartilage and connective tissue lining the rim of the acetabulum or hip socket. It is a condition that can usually be rectified using arthroscopy to perform the surgery. Labral damage can occur as a result of a fall or accident, but it is also common among sportsmen and women, such as golfers, soccer players, and ballet dancers, whose activities involve constant rotation of the joint. Patients with a torn labrum normally experience pain in the groin, in the side of their hip, or in the buttocks, as well as a clicking or catching sensation in the joint when they move it. Surgical treatment will most often take the form of debridement, in order to remove the damaged tissue, but in some cases, it may be possible to repair the damaged area with a graft.
FAI arises from abnormal contact between the surfaces of the ball and socket components in the hip joint, which then results in damage to the articular cartilage and possibly also the labrum. Arthroscopy is usually the procedure of choice when performing the reparative surgery. The procedure involves reshaping of both the femoral head and the acetabular socket as a means to prevent further impingement that, in the long term, could lead to an arthritic joint.
Depending upon the nature of the operation, two to four incisions of between 5 and 10 mm in length are all that is required. The procedures can take anywhere from 30 minutes to a couple of hours, and they are usually carried out under general anaesthesia. One incision is used by the scope and the others for the various instruments required. On completion, pain medication may be injected into the joint and the incisions are either taped, closed with one or two sutures, or left open before being dressed.
Some discomfort and swelling following hip arthroscopy and surgery are normal, but easily managed with medication. Some physiotherapy and a little time on crutches are all that should be required for a life-changing return to pain-free mobility.