Hip arthroscopy is a minimally invasive procedure used to diagnose and treat a wide range of conditions affecting the hip joint. This procedure can be used to confirm the diagnosis of various imaging procedures, such as X-rays and MRIs, as it provides the doctor with a three-dimensional, real time imaging of the affected area, allowing for the most accurate diagnostic results. If damage or abnormalities are detected during the diagnostic procedure, repairs can often be made during the same procedure, offering patients many advantages over traditional surgery.
Arthroscopic techniques can often be used to treat conditions such as:
• Labral Tears – The labrum is a ring of fibrocartilage that extends around the majority of the acetabulum, increasing its depth. The labrum acts as a suction seal around the femoral head maintaining the joint fluid within. The fluid protects the articular cartilage layers of the femur and acetabulum. The labrum does act as a stabilizer of the femoral head within the acetabulum as well. Labral tears are typically the result of some underlying etiology; BONY, SOFT TISSUE or TRAUMATIC.
Bony – Static Overload, Dynamic Impingement, Pincer Impingement
Soft Tissue – PSOAS Impingement, Laxity-Collagen Disorders
Traumatic – Subluxation, Dislocation
Labral tears most commonly result in groin pain. Most patients describe the pain as a sharp deep pain; increased activity tends to increase the level of pain. Oftentimes, patients do not complain of a constant pain in the joint, but rather one that comes and goes without warning.
• Femoroacetabular Impingement – Femoroacetabular impingement or FAI is a condition in which the femoral head, acetabulum, or both are shaped somewhat abnormally. Simply, the ball and socket do not fit perfectly, causing friction during hip movements, resulting in damage within the hip joint. The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper that surrounds the socket).
Impingement can occur as a result of femoral sided impingement (Cam impingement), acetabular rim impingement (pincer impingement), or a combination of both which is the case in the majority of patients.
• Gluteus Medius/Minimus Tears -Both the Gluteus Medius and Minimus act as abductors of the hip and are located on the outer aspect of the hip.
The muscles of the medius and minimus join and turn to tendon, inserting on the greater trochanter of the femur bone. A tear of the tendon typically results in pain over the lateral aspect of the hip, but more so, results in weakness. A tear does frequently result in gait disturbances.
• Snagging Hip Syndrome – Iliotibial Band tightness sometimes results in snapping over the greater trochanter (external snapping hip). Patients will often describe their "hip as dislocating," when in fact, it is the ITB snapping.
The pain felt from a snapping ITB is typically directly over the greater trochanter of the femur, located on the outside of the hip.
• Instability - Generalized ligamentous laxity/Collagen Disorders, i.e. Marfans, Ehlers-Danlos Syndromes.
• Loose Bodies/Tumors
• Other Soft Tissue Injuries of the Hip
During the hip arthroscopy procedure, the surgeon will make a small incision near the affected area of the hip and insert an arthroscope, a long flexible tube with a camera on the end that displays images of the inside of the hip joint to detect any damage. If damage is detected, it can be repaired during the same procedure by inserting surgical instruments through a few other incisions. The surgeon can replace damaged cartilage, join together torn ends, remove loose bodies or realign the joint to minimize pain and inflammation.
Hip Fracture Repair:
A hip fracture involves a break in the top of the femur when the bone angles toward the hip joint. Hip fractures are especially common in older patients and those with osteoporosis. They are usually extremely painful and require surgical repair to relieve pain and restore proper functioning.
During hip fracture surgery, an incision is made over the affected area and the bones are aligned back in place. The bones are often held in place with metal pins, screws, rods or plates while they heal, which may or may not be removed later on. The incision is then closed with sutures or staples. This procedure usually takes two to four hours to perform.
Total Hip Replacement:
Hip replacement is usually a last resort treatment for patients with severe hip pain whose daily lives are affected by the pain, including those with arthritis, fractures, bone death or other conditions. In this procedure, the diseased bone and cartilage are replaced with a metal ball and plastic cup.
The artificial joint, called a prosthesis, may be cemented in place, may be cement less, or may be a hybrid of both. The prosthetic devices provide pain relief and restored function for 25 years or longer in most cases.