Hip Arthroscopy – The Procedure and its Applications
Despite archaeological evidence in Croatia suggesting that the successful repair of fractures could date from as early as 130,000 years ago, there was little progress in treating damaged joints until more recently. Of course, a joint’s structure is more complex and includes muscles, tendons, ligaments, and protective membranes, which would have posed challenges for early surgeons and bonesetters. Nevertheless, in just a few decades, procedures like hip arthroscopy and total joint replacements have developed to a point where they are now a daily routine for many orthopaedic surgeons.
The instrument that helped to make such procedures possible was initially developed as a diagnostic tool. Those in other fields of medicine and surgery had long used similar devices to view the contents of body cavities like the gastrointestinal and urinary tracts, while some inserted scopes through the abdominal wall to identify problems. However, hip arthroscopy first became a practical option in 1918. An enterprising Japanese professor modified an instrument customarily used to examine the bladder and applied it to view the internal structure of a corpse’s knee joint.
The next few decades saw a series of improvements in the scope’s design and performance. However, despite its first use to examine a hip joint in 1931, the technique failed to gain widespread interest for several decades. The arthroscope is still routinely used by orthopaedic surgeons as a diagnostic aid. However, extending its use for therapeutic purposes established the value and the future of hip arthroscopy and corresponding procedures performed on other joints.
Following a tiny incision, a guidewire and cannula are used to insert the scope into the dislocated joint. A built-in LED and fibre-optic cable provide the illumination for a miniature video camera, which returns a magnified view of the examination area to a monitor screen. By manipulating the scope’s position, the surgeon can then explore the bone surfaces and soft tissue for signs of damage or disease and determine the next step. Frequently, that step will entail some form of surgical repair. Thanks to advances in hip arthroscopy, open surgery is no longer necessary to perform that repair. Instead, an additional two small incisions provide portals for the required surgical instruments, while the scope enables the surgeon to position and utilise them as necessary.
Today, this minimally invasive form of surgery is widely used to treat several conditions that affect this hard-working joint. Routine arthroscopic procedures include repairs to labral tears, lavage of bone and cartilage fragments, and the relief of sciatic nerve compression and femoroacetabular impingement (FAI).
The orthopaedic unit at Pretoria’s Life Wilgers Hospital is recognised locally and internationally as a leader in shoulder, knee, and hip arthroscopy.