Hip Arthroscopy

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

Hip arthroscopy is keyhole surgery of the hip. Through two or three small incisions (portals), a camera and fine instruments are placed into the joint. Because the hip is a deep, tightly-fitting ball-and-socket joint, gentle traction is applied to the leg to open it up so the surfaces can be seen and treated, and the capsule is opened to allow access. It lets a range of problems inside the hip be addressed without a large open operation.

What it is used for

Hip arthroscopy is used to:

●      Reshape the bone in femoroacetabular impingement (FAI) – trimming a cam bump on the ball or a prominent rim (pincer) on the socket so the hip moves without pinching

●      Repair, trim or reconstruct a torn labrum, and manage the capsule where there is instability

●      Remove loose fragments of cartilage or bone, and treat certain cartilage injuries and other sources of pain within the joint

It is not a treatment for established hip arthritis (where a hip replacement is more appropriate), and it is not suitable as an isolated procedure for a significantly dysplastic (shallow) socket, which usually needs the socket reorientated. Careful selection – younger patients, minimal arthritis, and the right diagnosis – is the strongest predictor of success.

Recovery and rehabilitation

Hip arthroscopy is usually a day or overnight procedure. Crutches are used for a period (often a few weeks) to protect the hip, and a staged physiotherapy programme progresses from restoring movement, to strengthening, to sport-specific work. Return to running and pivoting sport is typically over four to nine months depending on what was done inside the hip.

Outcomes and what the evidence shows

In appropriately selected patients, hip arthroscopy has good and durable results. Systematic reviews report high rates of return to sport – around 93% to any level and about 82% to the pre-injury level – with favourable patient-reported outcomes, particularly in younger athletes. For FAI specifically, the UK FASHIoN randomised trial found arthroscopy produced greater improvement in hip-related quality of life than a supervised physiotherapy programme, although both improved and the difference was modest, which is why good conservative care is usually tried first. A minority of patients – more often older patients or those with early arthritis – do not improve enough and go on to need a hip replacement.

Complications

Hip arthroscopy is generally safe, with a low overall rate of serious problems. Understanding the specific risks helps set expectations:

●      Minor complications occur in around 8% of cases and major complications in under 0.5%.

●      Traction-related problems – temporary numbness in the groin, thigh, foot or genital area (for example pudendal nerve irritation, reported in about 2%, and numbness over the outer thigh from the lateral cutaneous nerve), which almost always resolves within a few months. Pressure effects on the perineum are minimised by limiting traction time.

●      Infection and blood clots – both uncommon.

●      Heterotopic ossification – extra bone forming in the soft tissues, sometimes prevented with anti-inflammatory medication.

●      Iatrogenic damage to the cartilage or labrum during the procedure, and instability if too much bone or capsule is removed.

●      Incomplete relief of symptoms, progression to arthritis where wear is already present, and the possibility of further surgery including eventual joint replacement.

Summary

Hip arthroscopy is an effective keyhole option for impingement, labral tears and loose bodies in the right patient, with high return-to-sport rates and a low complication rate. It is not for established arthritis or dysplasia. Dr Spelman – who also performs hip preservation surgery such as periacetabular osteotomy – will advise whether arthroscopy is the right procedure for your hip and what it can realistically achieve.