The Nature of Hip Arthroscopy and its Common Applications

Dec 18, 2020 | Articles

Despite being among the last of the medical disciplines to enjoy the benefits of the endoscope, many orthopaedic surgeons would not hesitate to agree that this surprisingly simple concept has revolutionised the capabilities of their profession. In particular, hip arthroscopy has proved to be not just an invaluable diagnostic option but also a means to mitigate the invasive nature of several surgical procedures commonly performed on this hardworking joint.


In its basic form, the process begins by making a small incision near the head of the femur. Through this, a tubular endoscope is then introduced into the interior of the joint. A built-in miniature TV camera then relays live, full-colour images of the joint’s internal structure to an eyepiece or monitor in real-time. The surgeon is free to reposition the scope as required, to scan the entire area and to identify both the nature and extent of any disease or damage present.


During its early years, hip arthroscopy was performed only for diagnostic purposes. The value of this technique derived from the fact that it was a far more informative option than relying solely on the findings of a conventional x-ray image. Today, even though medical imaging technology has advanced by leaps and bounds, the arthroscopic examination has continued to retain its importance.


Earlier successes in adapting this technology to perform minimally invasive surgery on various structures within the knee inspired some to attempt similar interventions for other joints. It was not long before hip surgeons also began to adapt arthroscopy to perform therapeutic, surgical interventions, as well as an aid to diagnosis.


Many of the procedures that are now performed in this manner would, in the past, have required a surgeon to fully expose the joint. Not only does this result in a much larger incision that, in turn, requires more time to heal, but it can also carry a heightened risk of both excessive blood loss and infection. By contrast, these risks can be significantly reduced when adapting hip arthroscopy to perform minimally invasive procedures that require just two or three tiny incisions. While these procedures must be performed under general anaesthesia, overall patient recovery times following arthroscopic surgery also tend to be measurably shorter.


The range of interventions that can now be performed in this fashion has continued to grow as orthopaedic surgeons around the world have succeeded in developing new techniques and gained more experience. In the early days of hip arthroscopy, interventions were limited to simple resections of damaged tissues but, over time, new approaches were developed that enabled surgeons to perform effective repairs to the damaged tissues instead.


Today, although so-called keyhole surgery directed at various components of the femoroacetabular joint has become more commonplace, these are stringent procedures and still require the knowledge and skills of an experienced orthopaedic specialist.


Among the conditions that can now be surgically addressed with the aid of hip arthroplasty is a condition in which an outgrowth of bone occurs on the femoral head and/or the acetabular surface. Known as femoroacetabular impingement or FAI, the bony spurs can cause damage to soft tissue, causing pain and restricting movement. Synovitis, hip dysplasia, and infections can all be treated in this manner. However, undoubtedly, one of its most significant benefits of this minimally invasive option is that it can often obviate the need to perform a total hip replacement.


South Africa’s exceptional achievements in several fields of medicine have long been recognised internationally. It should, therefore, come as no surprise that this recognition extends to hip arthroplasty. Under the direction of Dr Jan De Vos, the orthopaedic unit at the Wilgers Hospital in Pretoria has become a centre of excellence that attracts numerous referrals from home, the neighbouring states, and many overseas countries.