Hip Arthroscopy

Overview

Hip arthroscopy, or commonly referred to as a hip scope, is a minimally invasive technique used to address issue with the hip joint. Most often, hip arthroscopy is used to treat femoroacetabular impingement (FAI) and labral tears. To do this, 2 small incisions are typically used, one for a camera and one for a working instrument. The hip is typically distracted during the surgery to allow enough room to work. A survey of the hip is typically performed first, looking at the cartilage surfaces of the acetabulum (cup) and femoral head (ball). If there are any defects of the cartilage they can be smoothed out or if there is a cartilage lesion that goes down to bone then a microfracture may be performed by poking small holes into the defect allowing the patient’s own stem cells to come to the surface and form a new fibrocartilage. The Ligamentum Teres (the ligament that attaches the femoral head to the acetabulum) is typically inspected as well looking for partial tear, hypertrophy (enlargement), or synovitis (inflammation).

Once the survey is done the acetabuloplasty (getting rid of bony impingement along the rim of the acetabulum, called pincer impingement) and labral repair are typically performed. Once the boundry between the labrum and capsule are developed, a bone burr is inserted and the bone shaved down. In some cases, an os acetabuli, or acetabular rim fracture, may be identified. If small enough, this is typically removed but if larger may need to be fixed in placed to not destabilize the hip. Once the bony resection is completed and the bone in this region is down to bleeding bone, the labrum is repaired using suture anchors. The anchors are placed into the acetabular rim and the suture attached is passed either around, or through the labrum and tied down to secure the labrum and allow the body to heal the labrum down to the acetabular rim. 

Once the labral work is completed, the hip is reduced and the femoroplasty (getting rid of bony impingement along the neck of the femur, called cam impingement) is performed. Care is taken during this part to visualize and protect the blood supply to the femoral head as the burr is used to shave down the bone. The hip is moved around during the surgery to perform a dynamic assessment to ensure there is no longer any additional impingement. 

Hip Arthroscopy can be a very successful surgery

Hip arthroscopy can be a very successful surgery with the right indications with the survivorship (no need for revision hip arthroscopy or progressing to a total hip replacement) is more than 90% at 10-years. If a microfracture is performed, then the survivorship at 10-years is around 75%. 

Potential Implications

Blood loss, infection, damage to nerves or blood vessel including numbness over the lateral (side) of the thigh, possible post-operative fracture if weight bearing performed too soon, deep vein thrombosis (DVT), and need for additional surgery.