Hip Arthroscopy:

Hip arthroscopy is a minimally invasive surgical procedure where an arthroscope is used to examine and treat problems within the hip joint. The arthroscope is inserted through small incisions, allowing for diagnosis and treatment with less pain, quicker recovery, and reduced risk of complications compared to open surgery.

Indications:

• Femoroacetabular Impingement (FAI): When extra bone growths on either the femoral head or acetabulum lead to joint damage from impingement. Arthroscopy can remove these bone spurs (cam and pincer lesions).

• Labral Tears: The labrum is a ring of cartilage around the hip socket that can tear due to trauma or FAI, causing pain and instability. Arthroscopy can repair or debride the labrum.

• Loose Bodies: Arthroscopy can remove loose pieces of bone or cartilage within the joint that cause pain or joint locking.

• Synovitis: Inflammation of the synovial membrane can be addressed by removing inflamed tissue.

• Chondral Lesions: Damage to the cartilage covering the joint surfaces can be treated with techniques like microfracture or chondroplasty.

• Hip Dysplasia: In some cases, arthroscopy might be used to address minor deformities or to assist in planning for more extensive reconstructive surgery.

• Snapping Hip Syndrome: Where tendons or muscles snap over bony prominences, causing pain or discomfort.

• Early Osteoarthritis: To debride damaged cartilage or remove bone spurs to alleviate symptoms, although this is more of a palliative measure.

• Unexplained Hip Pain: When other diagnostic methods have not clarified the source of pain.

Techniques:

• Patient Positioning:

  • Supine Position: Commonly used with the leg in traction to distract the joint, allowing access to the hip's interior.

  • Lateral Position: Less common for hip arthroscopy, used by some surgeons for better access to certain areas of the joint.

• Traction Setup:

  • Essential for creating space within the hip joint. Traction is applied to the leg to distract the femoral head from the acetabulum, increasing the joint space for arthroscope insertion.

• Portals:

  • Anterolateral Portal: Often used for viewing.

  • Anterior Portal: Commonly for instrument insertion.

  • Posterolateral Portal: For additional access if needed.

  • Mid-Anterior Portal: Useful for certain procedures like labral repair.

  • The exact location can vary based on surgeon preference and patient anatomy.

• Instruments:

  • Arthroscopes, shavers, burrs, radiofrequency probes, and various graspers or suture passers are used. Specialized instruments for hip arthroscopy have been developed due to the unique challenges of this joint's anatomy.

• Fluid Management:

  • High fluid pressure is required to maintain joint distraction and visibility. This can increase the risk of fluid extravasation, which must be carefully managed.

• Surgical Techniques:

  • Labral Repair or Reconstruction: Using sutures and anchors to reattach or regenerate the labrum.

  • Osteoplasty: Removing excess bone from the femur or acetabulum in cases of FAI.

  • Microfracture: For treating cartilage defects by stimulating bone marrow to produce new cartilage-like tissue.

  • Capsular Management: Addressing the joint capsule, which might involve plication for instability or release for contractures.

• Anaesthesia:

  • Usually general anesthesia combined with regional blocks for postoperative pain management.

The procedure's success largely depends on the surgeon's expertise due to the hip joint's complex anatomy and the technical challenges of working in a confined space under traction. Postoperative rehabilitation is crucial for a good outcome, focusing on regaining joint mobility, strength, and function.