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Hip Arthroscopy: Patient Guide to Hip Arthroscopy

Introduction

This information is aimed to provide a general guide to the common indications for hip arthroscopy; what to expect if undergoing the surgery, the significant risks, and a general guide to the expected recovery pathway. This information is not by any means fully comprehensive, and any particular questions should be addressed with your surgeon. Many different hip procedures can be performed arthroscopically, and from country to country, and surgeon to surgeon, there will be significant variations.

Indications for Hip Arthroscopy

Since the early 20th century, when hip arthroscopy was regarded as being almost impossible to undertake, the procedure has developed in leaps and bounds. Presently there are many reasons why a surgeon might recommend hip arthroscopy to a patient. Some of these reasons are as follows:

• To explain unexplained hip pain (diagnostic hip arthroscopy)
• Removal of loose or foreign bodies
• Repair of damaged articular cartilage (gristle)
• Removal or repair of a torn acetabular labrum (see below)
• Correction of femoroacetabular impingement (FAI – see below)
• Management of damaged hip ligaments
• Management of hip joint infection
• Inflammation of the hip lining (synovitis)
• Investigation of a painful joint replacement or hip resurfacing

Perhaps the two most common current indications for hip arthroscopy include the presence of symptomatic FAI or an acetabular labral tear, or both. These will be considered in more detail here:

Femoroacetabular Impingement (FAI) –

FAI is a condition affecting the hip joint and is characterized by abnormal contact between the femoral head (hip ball ) and the rim of the acetabulum (hip socket) leading to damage to the articular cartilage (lining or gristle) in the acetabulum, or to the labrum of the hip, or both. The labrum is a ring of cartilage that surrounds the acetabulum and looks very like the meniscus of a knee joint, although its function is different. Damage to the labrum and/or articular cartilage will likely cause pain. An abnormality in the shape of the femoral head or acetabulum, or both, may cause FAI. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact, e.g. kicking sports. FAI generally presents in three forms: cam impingement, pincer impingement and mixed impingement (involving both cam and pincer type). FAI can affect all age groups from the early teens to throughout adult life and is being increasingly recognized as one of the predisposing factors for osteoarthritis of the hip. Although scientific evidence is still slightly sketchy, it is felt by many that without early intervention surgery, there is a high likelihood of developing osteoarthritis ‘wear and tear’, with the subsequent requirement for either a hip replacement or other major hip operations. Hip arthroscopy can be used to reshape the femoral head and socket to prevent impingement, and aims to protect the hip from developing osteoarthritis, as well relieving current symptoms.

Acetabular Labral Tears –

The labrum, which surrounds the acetabulum, can be partially damaged or torn. This is usually associated with FAI, but not always so. With hip arthroscopy, the labrum can be either debrided (remove the damaged tissue only) or repaired. Occasionally a labrum can also be grafted. MRI and/or CT scans, although often performed before hip arthroscopic surgery is undertaken, do not always reveal every labral tear.

Read Detailed Outcomes of Hip Arthroscopy »

Guidance prepared on behalf of the International Society for Hip Arthroscopy (www.isha.net)

Authors: Singh PJ*, O’Donnell JM**, Pritchard MG**

*Nuffield Orthopaedic Centre, Oxford, UK
**Mercy Private Hospital, East Melbourne, and Bellbird Private Hospital, East Blackburn, Victoria, 3121, Australia