July 20, 2018
Arthroscopy is a surgical technique that has revolutionized the way that complex hip conditions are treated. For femoroacetabular impingement (FAI), also called hip impingement syndrome, an arthroscopic repair provides an effective and minimally-invasive alternative to traditional hip surgery. An arthroscopic procedure can also be an appropriate treatment for other common hip problems, including cartilage damage, labral tears, loose bodies, tendonitis, and bursitis. Often, patients of an arthroscopic surgery experience less postoperative pain and a faster recovery than those who receive a traditional procedure.
Arthroscopy has become a routine procedure. Despite all of its benefits, however, it is not an appropriate treatment for every condition or patient. The risk of a complication needs to be seriously considered and it is important to discuss your particular health factors with your surgeon.
This article provides answers to frequently asked questions about hip arthroscopy. For a better understanding of arthroscopy and to determine if surgery is the appropriate treatment for your hip pain or stiffness, schedule an appointment with a hip specialist.
What is Hip Arthroscopy?
Arthroscopic hip surgery is a minimally-invasive procedure that involves two to three small incisions, a high definition camera, and specialized instruments to work inside the hip joint.
The procedure begins with a small incision in the hip that is about 1 cm long. The surgeon then inserts a small camera, called an arthroscope, through the incision. The camera feeds video to a nearby monitor, providing the surgeon with an interior view of the joint. The surgeon will then perform one or two additional incisions in order to insert the specialized instruments they will use to repair the joint. The surgeon can reshape, remove, and stabilize the various components of the hip without fully exposing the joint. The surgery typically takes about two hours or less.
What Conditions Does Hip Arthroscopy Treat?
Hip arthroscopy can be used to surgically treat femoroacetabular impingement (FAI), or hip impingement syndrome. Arthroscopy is used to treat:
- Abnormalities of the femoral head: The head of the femur is reshaped and made smooth, allowing it to rotate through its full range of motion.
- Abnormalities of the acetabulum: The hip socket is reshaped, allowing the femoral head to fit more securely and rotate through its full range of motion.
- Labral tears: Torn labrum is reattached, repaired, and stabilized.
- Ligamentum Teres Tears: The ligamentum teres can be trimmed and stabilized.
- Bone cysts: Holes in the femoral head or acetabulum are removed or filled with a bone graft.
In addition to FAI, other conditions that can be treated by hip arthroscopy include:
- Cartilage damage
- Loose bodies
- Labral tears
- Iliopsoas tendinitis
- Trochanteric bursitis
- Synovial disease
- Adhesive capsulitis
- Joint sepsis
Hip arthroscopy can be performed if there are no apparent signs of arthritis. If moderate to severe arthritis is present, the surgeon may recommend a partial or total hip replacement instead.
What are the Advantages of Hip Arthroscopy?
Less Tissue Damage
Arthroscopic surgery preserves muscles in three ways. First, the surgeon only makes a small number of incisions that are each approximately 1 cm long. Second, the incisions are made on the front side of the hip where there is naturally less muscle. Finally, the procedure is performed with highly specialized instruments that allow the surgeon to work between tissue. The surgeon does not need to cut or remove tissue in order to access the joint.
These aspects of arthroscopic surgery are vastly different from traditional hip surgery. A traditional procedure involves a large incision that is approximately 10-12 inches long. Moreover, muscles and tendons are detached from bones and the femoral head is dislocated from the hip socket in order to have a complete view of the joint.
Less Postoperative Pain
Patients of arthroscopic surgery usually experience less pain because there is less tissue that needs to heal. These patients also require less pain medication.
Recovery time depends on the type of hip arthroscopy performed. If the purpose of surgery is to remove torn pieces of cartilage or foreign bodies from the hip, the patient may be able to place their full weight on the joint after two or three days. Alternatively, if the purpose of surgery is to repair the anatomical structures of the joint, the patient will often be able to resume activities within 3 to 4 weeks. Those who work less physically demanding jobs often return to work sooner. Patients of traditional surgery may need up to 8 weeks in order to return to activities.
Shorter Hospital Stay
At Beacon Orthopaedics and Sports Medicine, hip arthroscopy is performed in an outpatient setting. Outpatient hip replacement, also called a same-day hip replacement, allows the patient to receive surgery and return home within 24 hours of their surgery. Patients can not only recover in the comfort of their own home but they are also able to avoid the cost of a hospital stay.
What are the Risks of Hip Arthroscopy?
The risk of complications from hip arthroscopy is low and many of its potential complications are transient. However, it’s important for patients to understand the following conditions that can result from surgery:
- Blood vessel and nerve damage
- Blood clots and pulmonary embolism
- Fluid build-up in the body
- Extra bone around the hip
In general, the risk of a complication increases with age and a history of smoking. Although rare, serious complications can occur such as the loss of limb function or anesthesia complications that can lead to death. Your physician will provide a comprehensive evaluation of your health in order to determine your level of risk.
Who is a Candidate for Hip Arthroscopy?
Candidates for arthroscopic hip surgery suffer from severe pain or experience decreased mobility that limits their ability to live a normal life. Candidates typically have FAI, a labral tear (which may or may not be related to FAI), hip dysplasia, loose bodies in the hip area, or another condition that leads to hip pain and loss of function.
Candidates for hip arthroscopy range in age from late teens to people in their 50’s and 60’s. Patients who are young and healthy, in particular, tend to be good candidates because they have less tissue surrounding the joint. Because the hip joint is located deep within the body, minimal tissue makes it easier for the surgeon to operate.
Hip arthroscopy is not appropriate for patients with moderate or severe arthritis. Instead, the best surgical treatment is a partial or total hip replacement.
It is important to note that surgery is not appropriate for every patient. It is also considered a method of last resort. Your physician will first recommend conservative treatments, including physical therapy, to help you manage your hip pain, swelling, and stiffness. If you are not able to achieve significant pain relief and mobility, your physician may conduct a comprehensive orthopaedic evaluation to determine if surgery is the appropriate treatment for you.
- Arthroscopic hip surgery is a minimally invasive procedure. At Beacon Orthopaedics, you are able to return home within 24 hours of their procedure.
- Hip arthroscopy involves less tissue damage, less postoperative pain, and faster recovery. The advantages of an arthroscopic procedure are ideal for athletes and professionals who need to return to their activities quickly.
- Hip arthroscopy is appropriate when there is no or very mild arthritis. Moderate or severe arthritis cannot be treated with hip arthroplasty.
- Your choice of surgeon will significantly impact your outcomes. Arthroscopy is a technically demanding procedure.
Talk to a Hip Specialist
The sooner a condition is treated, the higher the probability of success. With time, an untreated condition worsens leading to irreversible cartilage damage and the development of arthritis.
Dr. Steve Hamilton is a board-certified hip surgeon at Beacon Orthopaedics and Sports Medicine who has performed a significant number of minimally-invasive procedures. He will determine if you are a candidate for arthroscopic hip surgery and talk candidly about what you can expect.
Schedule an appointment with Dr. Hamilton to discuss your options. For your convenience, he is available at Beacon East, Beacon West, or Summit Woods in Ohio or at Beacon’s Northern Kentucky location.