- What is Hip Arthroscopy?
- Who is a Candidate for Hip Arthroscopy?
- Anatomy and Function of the Hip.
- Diseases of the Hip.
- Non-Surgical Options.
- Reasons for Hip Arthroscopy.
- Preparing for Surgery.
- Surgery Day.
- Hip Arthroscopy Procedures.
- Post-Operative Care and Rehabilitation.
In the late 1970s and early 1980s, arthroscopic surgery became popular, especially in the sports world, as fiber optic technology enabled surgeons to see inside the body using a small telescope, called an “arthroscope,” which projects an image to a television monitor.
Thanks to ongoing improvements made by technology, the benefits of arthroscopic surgery for knee and shoulder conditions have been experienced by patients all over the world. By adopting techniques and instruments similar to those used in knee and shoulder procedures, arthroscopic hip surgery has become a more widely-used treatment option for those who suffer from hip pain.
Arthroscopic procedures may be used for a variety of hip conditions, primarily the treatment of labral tears, hip impingement, articular cartilage injuries, and the removal of loose bodies in the joint. Other less frequent conditions treated through hip arthroscopy include tendon or ligament injuries, hip instability, and an inflamed or damaged synovium. Because all of these conditions may eventually lead to hip arthritis, treating them with arthroscopic procedures may be a beneficial option for patients.
Through an incision the width of a straw tip, Dr. Rogerson is able to insert a scope, which allows him to inspect the joint and locate the source of your pain. Dr. Rogerson will then make one or more small incisions to accommodate the instruments used to treat the hip. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.
Arthroscopic hip surgery is usually preformed in an outpatient surgery center, which means no overnight hospital stay is required. You report to Meriter Hospital in the morning, undergo the procedure and following a recovery period under the care of medical professionals, return home later in the day.
In the past, patients suffering from hip problems had limited options. In most cases, they were forced to live with the pain until a total hip replacement was required. With the advent of arthroscopic hip surgery, however, there are now less invasive treatment options available that can provide relief or significant improvement for a number of conditions.
Most people who suffer pain or experience decreased mobility due to hip impingement, labral tears, cartilage injuries, loose bodies in the joint, or other conditions may benefit from a minimally invasive surgical procedure. This information will help you better understand the anatomy and function of the hip and will guide you through the steps of arthroscopic surgery used to treat hip conditions.
The hip, a ball-and-socket joint, is the largest weight-bearing joint in the body. When the joint is healthy, the head of the thighbone (femur) forms a round ball that fits into the acetabulum, a cavity at the base of the pelvis that forms the socket.
Ligaments connect the ball to the socket and keep them both firmly supported. The surfaces of the femoral head and the acetabulum are covered by a smooth, tough material known as articular cartilage, which cushions the bones and allows them to move easily. Around the rim of the acetabulum is a layer of fibrous cartilage called the labrum, which deepens the socket and provides a suction seal to hold the head of the femur firmly in place.
The other surfaces of the hip joint are covered by a thin, smooth tissue liner called the synovial membrane. This tissue produces a small amount of synovial fluid that acts as a lubricant and reduces the amount of friction that occurs when the bones move against each other.
Hip impingement is a disorder caused by a lack of room, or clearance, between the head and neck of the femur and the rim of the acetabulum. Due to this lack of clearance, when the hip is flexed, as in many common activities like running, sitting or bending over, the femur and the rim of the acetabulum rub together, causing significant pain in the joint. As a result of extensive contact between the femur and acetabulum, the labrum may suffer damage, slowly degenerate, and may even cause arthritis in the hip over time.
Hip impingement is more common in athletes or those who participate in strenuous activity who may aggravate pain in the groin area caused by impingement. Remaining in a stationary seated position for extended periods of time may also aggravate the condition. If conservative treatments are unable to relieve the pain you feel from hip impingement, Dr. Rogerson may recommend arthroscopic surgery.
The labrum is a layer of fibrous cartilage that lines the rim of the socket in which the ball of the femur sits. This cartilage provides cushioning for the joint and keeps the femur in place. A tear in the labrum can result either from injury or from degeneration due to impingement or other joint conditions.
In some cases, labral tears are not significant enough to cause symptoms and therefore don’t require surgical treatment. But occasionally they can cause symptoms such as locking or “catching” in the joint and pain in the hip or groin area.
Since labral tears are often difficult to detect during a physical examination, Dr. Rogerson may use magnetic resonance imaging (MRI) with a dye injection to confirm the diagnosis. Once the diagnosis is confirmed, arthroscopic hip surgery may be recommended.
Articular cartilage injuries:
Articular cartilage is a layer of material in the hip joint that covers the surface of the femoral head and acetabulum, cushioning them and allowing them to move against each other without causing damage. This cartilage sometimes tears or becomes damaged, either from high impact sports like running or jumping, as a result of friction caused by hip impingement, or from basic wear and tear.
When articular cartilage is damaged, the torn fragment often protrudes into the joint, causing pain when the hip is flexed. Also, the bone material beneath the surface no longer has protection from joint friction, which may eventually result in arthritis if left untreated. Articular cartilage injuries often occur in conjunction with other hip injuries, and like labral tears, may require an MRI with a dye injection to confirm the diagnosis. After confirming the diagnosis, Dr. Rogerson may recommend arthroscopic surgery.
Removal of loose bodies is a common reason physicians perform arthroscopic hip surgery. These loose bodies are often the result of trauma, such as a fall, an automobile accident, or a sports-related injury, or they may result from degenerative disease. When a torn labrum rubs continuously against cartilage in the joint, this may also cause fragments to break free and enter the joint. Loose bodies can cause a “catching” in the joint.
Unlike some hip conditions, loose bodies are relatively easy to detect with modern x-ray techniques. Once diagnosed, the removal of loose bodies through hip arthroscopy usually results in a significant reduction in hip pain.
Prior to undergoing any surgical procedures, there are some nonoperative, conservative options for treating your hip pain that Dr. Rogerson will consider. They include:
An exercise program may be prescribed to strengthen the muscles in the hip joint and in many cases improve positioning of the hip and relieve pain.
Non-steroidal anti-inflammatory drugs or NSAIDs, may help temporarily treat inflammation and pain in the hip joint. Please note, however, that all medications have risks and should only be taken under the direction of Dr. Rogerson.
In some cases, Dr. Rogerson may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Please note, however, that all medications have risks and should only be taken under the direction of Dr. Rogerson.
Arthroscopic hip surgery is considered when other conservative measures have not provided the required pain relief. It’s a positive measure to regain your active lifestyle that hip pain is preventing. Arthroscopic hip surgery may:
- Relieve pain
- Improve joint stability
- Remove loose bodies
- Repair tears and damage
- Delay the onset of osteoarthritis
- Delay the need for a total hip replacement
- Improve quality of life
- Optimize activities of daily living
Preparing for hip arthroscopy surgery begins weeks and sometimes months before the surgery date. Here are just a few things you should expect.
Initial Surgical Consultation
Preoperative X-rays, a complete medical history, a complete surgical history and complete list of all medications (i.e., prescription, over-the-counter, vitamin supplements) and allergies will be reviewed.
Complete Physical Examination
Dr. Rogerson will ask that you have a physical examination with your family physician to assist with optimization of medical conditions prior to the surgery. This will ensure that you are in the best physical condition possible on surgery day.
If deemed necessary, instruction in an exercise program to begin prior to the surgery, as well as an overview of the rehabilitation process after surgery, will better prepare you for postoperative care.
Loose-fitting clothing is recommended. Please bring the following three pieces of information with you to the hospital:
- A list of all your medications and dosages
- A list of all your drug allergies
Evening Before Surgery
It may be recommended that you do not eat or drink after midnight. You may also be asked to take some of your routine prescription medications with only a sip of water.
This is a brief overview of the activities that typically occur on your surgery day:
You will be admitted to Meriter Hospital.
- Your vital signs, such as blood pressure and temperature, will be measured.
- A clean hospital gown will be provided.
- All jewelry, dentures, contact lenses, and nail polish must be removed.
- An IV will be started to give you fluids and medication during and after the procedure.
- You will be asked to initial the surgical site with Dr. Rogerson’s initials.
- Your hip will be scrubbed and shaved in preparation for surgery.
- Renee Burke, PA-C, Joanna Hutchins, PA-C or Dr. Rogerson will meet you before your surgery just to say “Hi” and to answer your last minute questions.
- An anesthesiologist will discuss the type of anesthesia that will be used during your surgery.
Treatment of disease
Treatment of Hip Impingement
With hip impingement treatment, Dr. Rogerson will reshape the junction between the head and neck of the femur using small mechanical resection devices called burrs. Performing this step as well as trimming any excessive portion of the acetabulum will give the joint more clearance, thus relieving the impingement. At various times during the surgery and immediately following it, Dr. Rogerson will test and monitor your hip’s range of motion.
Treatment of Labral Tears
In this procedure, Dr. Rogerson will smooth the edges of the torn or frayed labrum using arthroscopic shaver blades or radiofrequency (RF) energy. Specially designed RF probes include flexible heads that allow Dr. Rogerson to maneuver through difficult curves in the hip joint, remove torn tissue, and smooth the damaged areas. In some cases, the labrum may be repaired. For this procedure, anchors will be attached to the bone and sutures will be passed through the tissue. The anchors are used to hold the suture in place.
Treatment of Articular Cartilage Injuries
To treat articular cartilage injuries, your surgeon will use an arthroscopic shaver blade to remove the damaged tissue, leaving a smooth, stable surface. Certain types of injuries may require treatment with microfracture. In this procedure, Dr. Rogerson will create a number of small holes in the exposed bone of the joint to induce bleeding and clotting, which also leads to new tissue growth. Studies indicate that in time, this new growth becomes firm tissue that is smooth and durable.
Loose Bodies Removal
When removing loose bodies, Dr. Rogerson will first use the visibility provided by the arthroscope to inspect the joint. This inspection will help confirm the number of loose bodies and their location. Dr. Rogerson will then retrieve and remove the loose bodies using specially designed hand instruments called graspers.
After surgery, you will be transported to the recovery room for close observation of your vital signs and circulation. You may remain in the recovery room for a few hours.The condition being treated will determine whether or not you will be required to use crutches when you leave the hospital and the length of time that the crutches may be necessary. Dr. Rogerson or his staff will provide specific information regarding your own postoperative plan.
Steps for rehabilitation following arthroscopic hip surgery vary depending on which procedure you had done.