Hip arthroscopy is perhaps the most rapidly evolving arthroscopic technique in orthopedics and the most discussed in international literature. The reason is that although it was first implemented about 20 years ago, it has been treated with a great deal of mistrust by the scientific community and was considered a very difficult, if not impossible, technique. However, the advancement of technology, the improvement of techniques, and the surgeons’ experience have led to the increasing use of the method by orthopedists. Also, long-term results from patients undergoing hip arthroscopy and recent publications in scientific journals have led to an “explosion” of orthopedic interest in hip arthroscopy worldwide.
Hip arthroscopy has come to complement the range of arthroscopic operations on the human body, as arthroscopy has already been successfully applied to the knee, shoulder, ankle and wrist joint. It is characterized by all the known advantages of the arthroscopic technique, that is, direct view of the joint on a TV screen, high diagnostic accuracy, ability to perform many therapeutic operations, minor surgical incision, short stay in hospital and rapid mobilization.
Which cases are indicated for arthroscopic surgery?
Candidates for hip arthroscopic surgery are potentially all patients who experience pain in the hip or groin area for more than six weeks and do not improve by other conservative means. However, great care should be taken by the surgeon, as patients with femoral bone disease (femoral head necrosis, transient osteoporosis) or advanced hip osteoarthritis are excluded.
The typical patient is 20-45 years old, with increased sports activity and groin pain associated with physical activity. Two are the most common conditions in which arthroscopic therapy is applied.
The first is the femoral head impingement, in which there is an abnormal shape of the femoral head which results in abnormal movement of the acetabulum and repeated injury to the acetabular cartilage (the cartilage around the acetabulum) and then to the glenoid cavity cartilage (the cartilage that covers the acetabulum). In fact, this condition has also been blamed for arthritis, that is, the destruction of the articular cartilage. The arthroscopic technique removes bone mass in the “abnormal” area with a special tool, thus trying to restore the normal shape of the femoral head, that is, the “sphere”, so as to create the proper conditions for smooth movement of the joint.
The second condition is the rupture of the acetabular cartilage that can be caused either by the aforementioned head impingement or by a traumatic event of a sudden and violent movement of the joint. Articular cartilage during arthroscopy may be diagnosed with a large rupture, a minor rupture or degeneration. Depending on the case, it is possible to use arthroscopic suturing (with special arthroscopic sutures), partial removal (partial resection of cartilage) or normalization.
The cartilage can also appear detached from the acetabular bone ring, whereby it can be repositioned with special bone anchors. Other conditions that cause hip pain and are treated with arthroscopy are the single lesions of the articular cartilage, loose bodies in the joint (osteochondromatosis), synovial diseases, round ligament injuries, septic arthritis (arthritis infection), early osteoarthritis, iliopsoas tendonitis, trochanteritis, hip fracture, while it can be used to diagnose osteonecrosis of the femoral head and in painful hip arthroplasties.
The surgical technique
The surgical technique is performed through three small incisions on the outer side of the hip (1 cm each). One incision is used for the camera, through which the image is transmitted, the other two for the tools. Both the camera and other tools have approximately the same diameter as a common pen. The duration of the surgery is 1 to 2 hours.
Hip arthroscopy usually does not require hospitalization in the clinic, although in some cases the patient stays in the hospital for only one night and is discharged the following day. Postoperatively there are three small surgical incisions on the exterior of the hip, which are closed by a single suture each. The surgical trauma is very small, thus significantly reducing morbidity and postoperative pain.
It is important to emphasize that postoperative rehabilitation is particularly important for the final result and should be based on specific protocols that should be adhered to with respect. The rehabilitation program is based on intensive physiotherapy, mainly kinesiology, which starts one week post-operatively and requires constant supervision and guidance by a physiotherapist and close collaboration with the surgeon. The patient undergoes a gradually intensified program, in order to gradually return to normal levels of physical activity.
Hip arthroscopy is a highly specialized surgical technique performed by specially trained orthopedic surgeons. Hip arthroscopy opens new horizons in hip surgery and creates new perspectives for interventions in conditions that are considered incurable, difficult to treat or difficult to operate due to technical parameters. We are expecting the results of specialist centers abroad to evaluate the additional possibilities of hip arthroscopy.