What is hip arthroscopy?
Hip arthroscopy is a minimally invasive procedure used to diagnose and treat problems inside the main and peripheral compartments of the hip joint. One of the most common problems that affect the hip is impingement, which can come with labral tears. The hip is a ball-and-socket joint, and around the socket is soft tissue that provides stability but is also very prone to injury.
Hip arthroscopy is different from arthroscopy of other joints. The hip is a larger joint, and the biggest muscles in the body span it, including the adductor muscles and the quad. That means the surgery needs a specialty table and a specialty type of anesthesia, and the joint has to be distracted to make space. Surgeons used to have to dislocate the hip. Now they don't. The joint is distracted, the camera goes inside, and small instruments are used to decompress the bone that is causing impingement and to fix the labrum if it's torn.
What is hip impingement?
Femoroacetabular impingement, or FAI, means there is more bone and less space for the soft tissue in the hip. A bone bump, spur or excess bone limits range of motion and puts pressure on the soft tissue between the bones, including the labrum. There are three types:
- Pincer: the socket has overgrowth or larger bone that can pinch the femur.
- Cam: the femur has a larger neck that can impinge on the socket.
- Combined: both the socket and the femoral neck are involved.
What are the symptoms of impingement and labral tears?
Patients can have pain on the outside of the hip that can be severe and disabling. They can have pain in the groin. They can have clicking, catching, giving out, snapping or instability, and difficulty walking and getting around. This can happen in younger patients and in athletes.
Who needs hip arthroscopy?
Hip arthroscopy helps people who have impingement and a labral tear. Other conditions can look similar, so Dr. Jay is careful to get an accurate diagnosis. Problems in the pelvis, hernias, and conditions of the muscles and tendons can masquerade as a labral problem or impingement.
He works up the lower back and checks the L3, L4, L5 and S1 nerve roots for compression. He checks the pelvis for hernias and other problems, and looks at the groin muscles and tendons for a sports hernia or similar issues. Sometimes he uses diagnostic injections: medicine is placed in the problem area, and relief of symptoms helps confirm that impingement or a labral tear is the cause before treatment starts. He says diagnosis is the biggest challenge, and the surgery itself is probably the easier part.
How is hip arthroscopy different from hip replacement?
Hip arthroscopy is a minimally invasive, camera-based procedure with small incisions and a faster recovery. Small instruments and a camera are used, and the surgery happens underwater, in fluid. These patients usually do not have severe cartilage loss or severe arthritis. They tend to be younger and more athletic, with injuries related to sports and activity.
Hip replacement is more invasive and requires an open incision, though it can still be done in a minimally invasive way. It is not a camera procedure. The cartilage is replaced with artificial titanium and high molecular weight polyethylene parts. Replacements are usually done for older patients with cartilage loss and severe, end-stage, bone-on-bone arthritis.
What happens during hip arthroscopy?
The surgery usually takes about an hour to 75 minutes. The patient is either asleep or under a spinal anesthetic. A special table, such as a HANA table, distracts the space between the ball and the socket so the camera can enter. An X-ray machine is used at the same time as the camera and arthroscopic equipment.
Dr. Jay usually uses two portals, sometimes three. These are tiny incisions, about a finger or nail width. Through them he can repair the labrum, decompress the pincer, or decompress the cam deformity on the femur and the socket.
What is recovery like?
After hip arthroscopy, labral repair, labral debridement, or what he calls femoroplasty or acetabuloplasty, patients can bear weight as tolerated right away. Most don't need crutches or a walker and can walk normally. Light, non-strenuous activities and activities of daily living resume within two or three days. A nerve block helps with pain right after surgery and wears off after one or two days.
The incisions are covered with small band-aids that come off in about three days, and then the patient can shower. Dr. Jay asks patients to avoid strenuous activity, heavy lifting and pivoting on the joint for the first two months.
What happens if hip impingement or a labral tear goes untreated?
Hip impingement and labral tears can cause disabling, uncomfortable and painful problems in younger patients. Over time, a labral tear and chronic impingement can progress to arthritis in the joint, with progressive arthritic changes. Treating the impingement and the labrum helps with pain and disability, and may also decrease the chances that the hip keeps deteriorating and needs a total joint replacement.