Arthroscopy, Hip

An arthroscope is an instrument that allows your physician to look directly into the joint that is bothering you. It is about the size of a pencil, and it is attached to a video camera. Your physician can put the arthroscope inside your joint and observe the structures in your joint on a television monitor.

Arthroscopy was initially used to help diagnose problems of the knee. It showed physicians things never seen before and has proven to be an excellent diagnostic tool. Technology has progressed to allow physicians to look into the knee, shoulder, ankle, elbow, hip, wrist, hand, and even the big toe. The arthroscope is also being used in some situations, although uncommonly, to look within tendon sheaths.

Hip arthroscopy is being performed more frequently; as we are able to image the hip better to identify injuries, we understand more about it. As a result, arthroscopic techniques are advancing with better surgical tools and instruments.

Technology has also progressed sufficiently to allow surgeons to surgically treat the problems seen with the arthroscope. Specially designed surgical instruments are used to remove and repair damaged tissue. Techniques include trimming tissue, removing loose bodies (fragments of cartilage or bone) within joints, suctioning debris, obtaining tissue for biopsy, smoothing and recontouring rough surfaces and extra bone, removing inflamed tissue, stimulating cartilage growth, tightening tissue, and sewing (suturing) and tacking cartilage. How much can be done within the hip is dependent on technology and instrumentation that is still evolving; surgeon skill, the depth and contour of the hip joint, and our understanding of the body and joints all affect the success of surgical treatment.

The main benefits of arthroscopy are that it allows the surgeon to reach a more accurate diagnosis to prescribe appropriate treatment, and surgical procedures are usually performed through small incisions (¼ inch) that heal quickly and cause less pain and trauma to the tissues. This allows for better and quicker healing of many problems, which is particularly true for hip arthroscopy as compared with standard “open” hip operations. The key is that the same surgeries once performed open with large incisions can now be performed arthroscopically, without the big incisions and without the need to dislocate the hip, which is often necessary for open hip surgery. Further, most surgeries performed arthroscopically are done on an outpatient basis, because it causes less trauma to do the procedure through the smaller incisions. Although some surgeries may require hospital admission, regardless of whether a surgery is performed arthroscopically, full recovery requires a period of healing and rehabilitation.

Hip arthroscopy is different than arthroscopy of other joints, because the hip is deep within an envelope of soft tissue comprising muscle, tendon, and varying degrees of fat. Further, the hip joint is constrained by the depth of the rounded socket and the ball within it. As such, traction is needed to allow access to the joint; it is generally not needed to scope other joints.

To perform hip arthroscopy, the patient is placed on a special table that has a padded post situated in the groin area, and a device is used to pull on the foot of the leg to be operated upon. This pulls the ball away from the socket. The ball does not need to be pulled completely out of the socket, as is done with open hip surgery. Some surgeons prefer other techniques to separate the ball from the socket for hip arthroscopy: ask your surgeon what he or she uses.

Another difference between hip arthroscopy and arthroscopy of other joints is that fluoroscopy (live x-ray) is usually required with hip arthroscopy. Because the hip joint is so deep, it is difficult to feel the bones of the joint through the skin; fluoroscopy allows the surgeon to see exactly where the joint is, which allows placement of instruments into the joint without causing unnecessary damage to other structures about the hip. Usually 2 to 4 portals are used to perform hip arthroscopy.

Before doing arthroscopy, a complete evaluation is needed to have the most accurate diagnosis possible. Evaluation may include a medical history, physical examination, special diagnostic tests, and imaging studies. On the basis of these, arthroscopy may be indicated to confirm the diagnosis, and your surgeon will often correct the problem at the same time.

Arthroscopy is usually done as an outpatient surgery, and you will go home the same day, but sometimes it requires hospitalization. Hip arthroscopy may be performed under spinal or epidural anesthesia, which numbs the lower extremities only, or general anesthesia, in which you are completely asleep. The method used depends on the needs of the patient, the surgeon, and the problem being treated, but general anesthesia is usually preferred.

Because the hip is deeper than the other joints, the surgeon will need to go through more tissue to get into the joint; with the need for traction, recovery from simple hip arthroscopy is slower than after knee or shoulder arthroscopy.

If you ask your surgeon ahead of time, you may be given pictures and/or video of your hip arthroscopy operation. Do not eat or drink anything for at least 8 hours before surgery. Food and drinks, including water and coffee, make general anesthesia more hazardous.

When to call your doctor

Call our office if any of the following occur after arthroscopy:

• You experience pain, numbness, or coldness in the extremity operated upon.

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