Even the most cursory review of the history of medicine will reveal the incredible advances in the diagnosis and treatment of injuries and illnesses that have occurred since the earliest known efforts of ancient physicians. Though perhaps not immediately apparent, progress in the fields of medicine and surgery has been exponential. While more than 4 000 years passed between Imhotep’s writings on the diagnosis and treatment of 200 diseases and the invention of the microscope, the first hip arthroscopy was performed less than 350 years later, in 1931.
However, almost a century before the development of a suitable instrument made this kind of procedure available to the orthopaedic surgeon, a French physician named Desormeaux used a forerunner of that instrument to examine the bladder and urethra. Modifications and improvements to this early prototype saw endoscopic examinations gain popularity within many other disciplines of medicine. In practice, hip arthroscopy became possible because of a modification to an early cystoscope – to the type of endoscope normally used to examine the urinary tract.
At the time of this modification, however, it was not used to examine the hip. When Tokyo University’s Professor Kenji Takagi first hit on the idea in 1918, his purpose was to examine patients with tuberculous knee joints. His initial success prompted him to seek ways to improve the performance of his prototype and, by 1938, he had perfected a practical instrument that would provide the basis for future attempts to perform hip arthroscopy. However, although the latter procedure was first described by an American surgeon named Michael Burman in 1931, it was only during the 1990s that it gained worldwide acceptance among the orthopaedic community.
Most of those who pioneered the use of these instruments conducted their initial training on cadavers and their primary role was that of a diagnostic tool. The scope’s basic design consists of a hollow tube fitted with an eyepiece and lens to provide a magnified view of the joint and some form of illumination to improve visibility. That said, hip arthroscopy has only gained value because of the influence of modern technology on that basic design. These instruments now employ fibre-optic cable and intense white light from powerful LEDs in place of an incandescent lamp. Instead of an awkward eyepiece, images of the joint’s interior are captured by a video camera and relayed to a high-resolution monitor for the surgeon and other theatre staff to view with ease. The resulting, magnified, full-colour images are far more informative than an X-ray alone.
However, hip arthroscopy’s full potential was only realised when it ceased to be seen merely as a diagnostic aid and orthopaedic surgeons began to adapt its use for therapeutic purposes. Once again, the knee was the first joint to become the target of the new technique known as arthroscopic surgery. Professor Takagi must also receive the credit for being the pioneer in this endeavour when he began to use his scope to treat neuropathic, tuberculous, and infected knee joints during the late 1930s.
By contrast, hip arthroscopy was only refined sufficiently for surgical purposes between the late ’80s and early ’90s. However, in combination with a range of purpose-designed, miniature surgical instruments, the resulting minimally-invasive procedures are proving to be invaluable. Arthroscopic techniques have not only enabled surgeons to minimise the risks associated with open surgery but have even allowed them to treat some previously untreatable conditions.
Many orthopaedic surgeons now specialise in hip arthroscopy for both diagnostic and treatment purposes, often extending their interest to include work on other joints such as the knee and shoulder. South Africa boasts one of the leading national and international referral centres for this type of procedure – the orthopaedic department of the Wilgers Hospital in Pretoria.