Hip Arthroscopy

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Hip arthroscopy refers to surgery in the hip joint performed through small incisions (key hole) using specialized equipment to manage injured areas of the hip joint. This is a highly sub specialized field in Orthopaedic surgery that has advanced in the last few years due to a better understanding of hip joint problems, and technological advancements in surgical equipment. Formerly, the surgeon needs to dislocate the hip joint in order to reach the damaged joint structures. With hip arthroscopy, the same can be achieved in a much less invasive manner, leading to less pain following surgery and faster recovery.

Problems of the Hip Joint

The hip joint is a major joint in the body made up of the ball of the upper end thigh bone called the femoral head, contained in the hollow socket of the pelvic bone called the acetabulum. The contact surface of the joint is covered by cartilage, which is a smooth lining tissue. The labrum is a thick layer of supporting tissue that surrounds and seals the hip joint. A layer of covering tissue called synovium lines the inside of the joint providing nutrition fluid to the joint tissues.

The functioning of the hip joint is very intricate, and damage of the structures mentioned above will cause problems. These problems can present in various manner. Some individuals may notice a gradual worsening of deep aches, or a sudden traumatic event leading to a painful limp. In some cases, the pain may be accompanied with a loud snap or clicks when moving the hip. When there is stiffness in the joint, there will be difficulty bending the joint during daily activities such as squatting down, getting out of the car, or crossing legs to tie shoelaces. The hip pain is usually made worse with impact-loading activities like running and jumping, and extreme movements of the joint like squatting down or stretching. At night, the pain and discomfort may disturb and affect sleep.

The Role of Hip Arthroscopy

Some of the conditions that can cause hip symptoms include tears of the labrum or cartilage, loose bodies in the joint, bone growth causing hip impingement, rupture of the ligament of the head of femur (ligamentum teres), and painful snapping tendons around the joint. Hip arthroscopy is useful to thoroughly assess the damaged tissues and address these bothersome conditions.

1. Labral Tears

The labrum may be damaged in joint injury or through "wear and tear" of chronic overuse. In such instances, the damaged labrum can get caught in the joint during movement, causing pain or catching sensations. Hip arthroscopy is useful to trim out the damage labrum. In some cases, the damage labrum can be repaired with sutures.

2. Cartilage Damage

The lining cartilage of the joint may be focally damaged following injury. The damage joint surface may have unstable flaps of tissue that catches during hip movement. These flaps can be smoothened out during hip arthroscopy. Sometimes, the surgeon may make small drill holes in the bare area of the joint surface to try to stimulate scar cartilage healing.

3. Loose Bodies in Joint

Pieces of cartilage or bony fragments may be trapped in the joint, and these fragments can get caught during hip movement. They can be removed through hip arthroscopy.

4. Hip Impingement

In some individuals, abnormal bone growth around the neck of the femur or the rim of the acetabulum can cause early pinching of the joint during normal hip movements. This condition is also known as femoroacetabular impingement, or FAI. Repeated impingement can lead to premature breakdown of the cartilage and labral tissues of the hip joint. Hip arthroscopy allows the surgeon to identify the area of bony impingement and remove the excess bone spurs. At the same time, the damaged cartilage and labrum can be levelled off or repaired.

5. Rupture of the Ligamentum Teres

This ligament can rupture following hip dislocations. The loose ends of the damaged ligament can cause joint irritation during joint movement. This can be trimmed and smoothened off during hip arthroscopy.

6. Painful Snapping Tendons

Most snapping tendon problems can be dealt with satisfactorily without surgery. In some individuals, these painful tendons snap despite medications and therapy. Hip arthroscopy is useful to help release the tight tendons causing the pain and snapping sensation.

Conclusion

In short, hip joint problems are well-known occurrences that can cause significant disruptions to your daily life at work and at play. Some of the difficulties you have experienced in your hip can be improved with hip arthroscopy. If you are bothered by troublesome hip problems, you may want to seek advice from your doctor. Your doctor will be able to help identify the cause of the problem, and help you get back on your feet, and onto the road to recovery.

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Expert Author:
Dr Chong Kian Chun, Island Orthopaedic Consultants