Hip arthroscopy

Arthroscopy is a surgical procedure that gives doctors a clear view inside a joint. This helps them diagnose and treat joint problems.

During hip arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the hip joint. The camera displays images on a high-definition monitor, and the surgeon uses these images to guide/manipulate miniature surgical instruments.
Hip arthroscopy has been used for many years, but is not as common as knee or shoulder arthroscopy.

Anatomy

The hip is a ball and hinge joint. This arrangement gives the hip great mobility, which is necessary for daily activities such as walking, standing and climbing steps.
Understanding the construction of the different layers of the hip and its connections helps to understand how this joint works, how injuries can occur and how difficult it can be to recover from such injuries. The deepest layer of the joint consists of the bones and the joint itself. The next layer is the ligaments of the joint capsule. Tendons and muscles are the next layer.

The important structures of the hip can be divided into several categories.
These include:
– bones and joints;
– ligaments and tendons;
– muscles;
– nerves;
– blood vessels;
– bursae

Bones and joints

The bones of this joint are the femur and the pelvis. The proximal end of the femur is shaped like a ball. This ball is called the femoral head. This femoral head fits into a rounded socket at one end of the hip bone. This is called the acetabulum.
The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A larger ridge is found at the end of the femur, near the femoral neck. This ridge, called the greater trochanter, can be felt laterally. Large, important muscles are inserted at the level of the greater trochanter. One of them is called the gluteus medius muscle; it is a key muscle for stabilizing the pelvic limb during walking.

Articular cartilage is a material that covers the bony ends of any joint. Articular cartilage is about 0.6 cm thick in weight-bearing joints such as the hip joint. This cartilage is shiny white and has a rubbery, slippery consistency, which allows the joint surfaces to slide past each other without causing injury. The function of articular cartilage is to absorb shock and provide a very smooth surface to facilitate movement. There is articular cartilage wherever two bone ends move side by side or articulate.
At the hip, the articular cartilage covers the end of the femur and the hollow portion of the acetabulum at the level of the hip bone. The cartilage is particularly thick in the region of the socket, as this is where the greatest forces occur when walking or running.

Ligaments and tendons

Ligaments are soft tissue structures that connect bones together. A joint capsule is a waterproof sac surrounding the joint. In the hip, the joint capsule is made up of a group of three strong ligaments that connect the femoral head to the acetabulum. These ligaments are the main stabilizing force of the hip. They hold the hip in place.
A small ligament connects the top of the femoral head to the acetabulum. This ligament, called the teres (round) ligament, does not play a role in controlling hip movement as the main ligaments do. However, there is a small artery within the ligament that provides a small part of the vascularization of the femoral head.
A long band of tendon runs along the femur from hip to knee. This is the iliotibial band. It provides an insertion point for several hip muscles. Too short an iliotibial band can cause hip and knee problems.
A special type of ligament forms a unique structure inside the hip called the labrum. This labrum is attached almost completely around the edge of the acetabulum. The shape and the way the labrum is attached creates a deeper cup for the acetabular notch. This small rim of cartilage can be injured and cause hip pain.

Musculature

The hip is surrounded by thick muscles. The gluteal muscles form the muscles in the buttocks and behind the hip. The inner thigh is also made up of the adductor muscles. The main action of the adductors is to bring the thighs together.
The muscles that flex the hip are in front of the joint. These include the iliopsoas muscle. This deep muscle originates in the lumbar and pelvic region and inserts on the inner side of the upper femur. Another large hip flexor is the rectus femoris. This muscle is part of the quadriceps, the largest muscle group on the anterior aspect of the thigh. The smaller muscles originate in the pelvis and run up to the hip to help stabilize and rotate it.
Finally, the muscles found on the posterior aspect of the thigh originate in the pelvis. As these muscles cross the posterior aspect of the hip joint on their way to the knee, they help to extend the hip.

Nerves

All the nerves running through the thigh pass through the hip. The main nerves are the femoral nerve on the anterior side and the sciatic nerve on the posterior side. A small nerve, called the obturator nerve, also passes through the hip.
These nerves carry signals from the brain to the muscles to move the hip. These muscles also carry signals from the brain about sensitivity such as touch, pain and temperature.

Blood vessels

Next to the nerves the thigh is crossed by large blood vessels that vascularize the lower limb. The femoral artery, a large artery, originates deep in the pelvis. It passes on the anterior aspect of the hip and crosses the thigh towards the inner aspect of the knee. The pulse of this artery can be felt in the groin.
The femoral artery has a deep branch, called the deep femoral artery. This sends two blood vessels to the hip joint capsule. These blood vessels are the main source of vascularization of the femoral head. As mentioned above, the teres (round) ligament contains a small blood vessel that supplies very little blood to the top of the femoral head.
Other small vessels form inside the pelvis and vascularize the posterior portion of the buttocks and hip.

Fellowships

Where friction usually occurs between muscles, tendons and bones, serous bursae are usually found. A bursa is a thin sac containing a fluid that lubricates the area and reduces friction. The bursa is a normal anatomical structure. The body will actually produce a bursa if friction occurs.
A bursa that sometimes causes hip problems is the bursa between the greater trochanter and the muscles and tendons that cross it. This bursa, called the bursa of the greater trochanter, can become irritated if the iliotibial band is too tight. Another bursa is found between the iliopsoas muscle where it passes in front of the hip joint. This bursa is called the iliopsoas bursa. Another bursa is found above the ischial tuberosity, a bony formation in the buttocks on which a man sits.

When is hip arthroscopy recommended?

Your doctor may recommend hip arthroscopy if you have hip pain that does not respond to non-surgical treatment. Non-surgical treatment includes rest, physiotherapy, physiokinesiotherapy, drugs or injections that can reduce inflammation. Inflammation is one of your body’s normal reactions when an injury or disease occurs in your body.

Hip arthroscopy can relieve painful symptoms, labral lesions, articular cartilage lesions, or other soft tissues surrounding the joint. Causes include:

– Femuroacetabular impigment (FAI)

– Hip dysplasia

– Snapping hip syndromes(iliotibial retraction)

– Sinovita.

– Loose cartilage fragments in the joint

– Infection in the hip joint

Preparing for surgery

For hip arthroscopy you should have a complete clinical examination. Following this examination, the doctor will identify problems that may arise during surgery.

If you present certain risks, your doctor will ask you to do a more thorough evaluation before surgery. Inform your orthopaedic surgeon of any medications or dietary supplements you are taking. They will tell you whether you can continue or stop taking them before surgery.
Your doctor will contact you before surgery to give you information about the procedure. Follow the instructions given and do not eat or drink anything the night before surgery.

Before surgery, an evaluation by a member of the anesthesia team will also be necessary. Hip arthroscopy is most commonly performed under general anesthesia. Local anesthesia, such as spinal or epidural, may also be used. Local anesthesia means you are awake, but your body is numb from the waist down. The orthopedist and anesthesiologist will discuss with you which method of anesthesia is best.

Surgical procedure

Before surgery your leg will be mobilized. This means that the hip will be pulled out of the socket long enough for the surgeon to insert the instruments, to visualize the entire joint.

After mobilizing the leg, the surgeon will make a small puncture in the hip (about the size of a button) to insert the arthroscope. Through the arthroscope, the doctor can visualize inside the hip and identify damage.

The surgeon will insert other instruments through separate incisions to treat the problem. A number of procedures may be performed, depending on the hip condition. For example, the surgeon may:
– Abrasion of torn cartilage
– Removal of osteophytes
– Removal of inflamed synovial tissue
The length of surgery will depend on what the surgeon finds inside the joint.

Complications

Complications following hip arthroscopy are few and rare. Any surgery on the hip joint carries a small risk of injury to the surrounding nerves. The traction applied to the leg required for surgery may stretch the nerves and cause numbness, but this is usually temporary.

There are also small risks of infection, such as blood clots in the legs (deep vein thrombosis).

Recover

Your surgeon will design a recovery plan based on the surgical procedures used. In some cases, crutches are necessary. If the surgery has been more extensive, then there is a possibility that the use of crutches may be for a month or two.

In most cases, physiokinetotherapy is necessary for recovery. Specific exercises are important to restore strength and mobility.

Long-term results

Many patients are able to return to their daily activities after arthroscopy without being restricted in any way. Recovery depends on the type of surgery applied to the hip.
For some patients, lifestyle changes can be made to protect the joint. This will be decided by the orthopedist.

Sometimes, the damage to the hip joint can be so severe that it cannot be repaired, meaning the operation is a failure.

Future developments

Arthroscopy has helped doctors and researchers to better understand and discover more hip joint problems. Surgical techniques are evolving, and it is anticipated that hip arthroscopy will play a much more important role in diagnosing and treating hip joint diseases.