What is Hip Arthroscopy?
Arthroscopy is a minimally invasive procedure for examining, diagnosing, and treating joint problems. Through small incisions we are able to introduce a surgical instrument with a camera (scope) to evaluate the hip, which is made up of the ball (femoral head) and socket (acetabulum). This “scope” allows a surgeon to see inside the hip, find any abnormalities, and treat the problem, all during one minimally invasive procedure.
Arthroscopy is widely known to treat problems in the shoulder and knee, popularized in the news in professional athletes. However, it is only in the last 20 to 25 years orthopedic surgeons have been using this technique for hip procedures. In the last 10 years, the number of arthroscopic hip procedures has grown similar to knee arthroscopy in the 1980s, with estimates of 75,000 to 100,000 cases done per year in the United States. This is nearly a 200% increase in the number of arthroscopic hip procedures done yearly in the United States.
How hip pain was treated in the past
Prior to hip arthroscopy, if conservative treatment failed to resolve the pain from conditions of the hip such as arthritis, impingement or labral tears, the only surgical option was a hip replacement. As a result, many patients endured pain, restricted motion, and activity limitations, until a hip replacement was a surgical option, and in most cases, this was limited until the patient was nearing their 60s.
Hip arthroscopy allows the surgeon to better diagnose hip problems and has changed the game with respect to treating hip pathology. Through little incisions a significant amount of work can be performed to make people better without a large, more invasive procedure.
Common conditions treated with hip arthroscopy
- femoral acetabular impingement (FAI)
- pediatric conditions such as hip dysplasia, Perthes disease, and slipped capital femoral epiphysis
- labral tears
- loose bodies
- foreign body removal
- septic arthritis
- avascular necrosis
- tendon injuries and bursitis
- snapping hip
- post-operative hip replacement conditions
Candidates for hip arthroscopy
When conservative treatment such as activity modification, anti-inflammatory medication, physical therapy, or injections has failed, and the patient continues to experience pain, instability, or other symptoms, hip arthroscopy is a reasonable option to evaluate and treat the hip. Prior to surgery, all patients are screened for any medical problems or potential issues that may complicate surgery or rehabilitation.
Recovering from hip arthroscopy
Following arthroscopic surgery, the patient is discharged home, weight-bearing on crutches. A physical therapy program is tailored to each patient's individual findings from surgery, starts in the first week and continues for approximately three to four months. Often, rehab will proceed at home indefinitely to maintain range of motion and strength. Generally, patients return to most activity in four months, although activity differs between young and older “athletes,” those age 45 and older with arthritis, and the patient looking to return to work.
When to talk to a doctor
I encourage individuals to talk to their doctor or a specialist with complaints of hip pain, instability, or difficulty with daily life, such as climbing stairs, sitting, or work-related activity. Conservative treatment may begin and hopefully start the patient on the road to less pain and improved function.
Arthroscopy is a powerful tool to evaluate and treat the hip. In certain instances, we discover problems not clearly demonstrated on X-ray or MRI. It is important patients have a clear understanding of the work required to rehabilitate following hip arthroscopy. Having a detailed discussion with your surgeon is critical to manage post-operative expectations.
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