Hip arthroscopy has been around for a number of years. More recently, we have developed a better understanding of what conditions can be treated with keyhole surgery of the hip. Better instrument design has allowed us to do more in the hip with keyhole surgery. There are a number of conditions which can now be treated. The commonest ones dealt with are:
Labral tears – this is when the rim cartilage (labrum) at the edge of the hip socket gets torn. Sometimes, it can be repaired but in other cases, it is too badly damaged and so is trimmed back (debridement) to leave a stable section which does not interfere with hip flexion.
Femoroacetabular Impingement (FAI) – Sometimes, there is an underlying anatomical problem with the hip socket (acetabulum) and/or the ball of the hip joint (femoral head). These can cause limitation of movement because extra bone from the ball or socket can impede movement of the hip. A labral tear can also occur. If a labral tear is associated with one or both of these abnormalities, more extensive treatment may be required to deal with it. This may require trimming back the bone surrounding the hip socket (pincer excision) or ball (cam lesion on the femoral head). If this is the case, the labrum may need to be removed first to allow the pincer to be trimmed before it is reattached to its new position.
Osteoarthritis – Younger patients with early degeneration in the hip may benefit from inspection of the hip and debridement of tears or cartilage defects at the edge of the hip socket. A series of drill holes is sometimes made where the cartilage has worn away completely and the bone is exposed. This is called microfracture and is designed to try and get some cartilage to cover the bone. The cartilage will not be as good as the cartilage which has worn away but may provide some temporary benefit to delay hip replacement surgery in active younger people who would like to keep their own hip as long as possible.
Other conditions – Ligementum teres (a ligament within the hip socket) tears and inflammation can also be trimmed to relieve pain. The function of this ligament is still not well understood. Some centres offer ligamentum teres reconstruction, but the procedure is still in its experimental stages.
Other important information - The procedure is usually done as a day case, so you go home the same day. Occasionally, overnight stay is required. Following surgery, some restrictions will usually be imposed on movement and weight bearing through the operated hip. The physiotherapist will come and see you following surgery and start your tailored rehabilitation program.
You can download my post-operative hip arthropscopy protocol here.