Hip Disorders

Treatment Options

Hip Arthroscopy
Hip arthroscopy is a recently available procedure for the treatment of certain abnormalities of the hip. Due to the powerful muscles that cross the hip, entry into the joint requires the use of a distraction system. For cases of hip arthroscopy, the leg is usually distracted using a leg holder. The traction allows the entry of instruments into the hip joint for direct examination of the articular cartilage and evaluation of the soft tissue rim around the hip socket known as the labrum.

One of the common sources of hip pain in young patients is damage to the labrum from overuse or from an accident. Hip arthroscopy allows the surgeon to evaluate and treat such tears of the labrum.

Additionally, hip arthroscopy can be used to treat hip impingement, particularly in cases of cam impingement due to an aspherical femoral head. It has also been applied to the treatment of snapping of the hip due to the iliopsoas tendon rubbing on the edge of pelvic brim. The surgery takes approximately 1 hour and is performed under general anesthesia. Usually, a total of 2-4 skin incisions are used and these are located on the outer aspect of the hip. Most patients can go home the same day. Crutches are usually required for about 2 to 3 weeks.

This procedure provides significant advantage to open procedures of the hip due to the relatively expedient recovery and the substantially decreased blood loss and muscle dissection.

FAQ - Hip Arthroscopy

• I have heard of arthroscopy... I have heard that it is a relatively minor surgery. Is that true?
Although arthroscopy is a relatively non-invasive surgical procedure in the knee and shoulder, it is actually somewhat more challenging in the hip. The main difficulty is the depth of the hip joint below the skin and the powerful muscles which cross the joint. Also, since the hip is a ball and socket joint, it does not allow the introduction of instruments unless traction is applied to the leg. Traction complications are the most common complication of hip arthroscopy. Some patients can have numbness in their foot or in the pubic area from the leg holder and the padded post used for distracting the hip joint. This can last for several weeks.


• What types of problems can be helped with hip arthroscopy?
Hip arthroscopy is very valuable in its ability to directly look at the cartilage of the hip joint, to remove loose bodies, to clean up (debride) a torn labrum, clean infections, treat cartilage damage, avascular necrosis, and in some cases to reshape the femoral head in cases of hip impingement.


• How is the procedure performed?
We perform the procedure in the supine position (patient lying on their back). The patient is placed on a traction table and their leg is placed in a well-padded boot. Traction is applied to allow entry of the instruments into the hip joint. A mobile x-ray unit (fluoroscopy) is used to confirm the position of the instruments in space. Once the joint is entered, a camera is used to project views of the inside of the joint under high magnification onto a television screen. Through another entry hole, instruments are entered into the joint to assess and debride the various components of the joint.


• What is the success rate of the surgery?
In cases of isolated tears of the labrum, the success rate is very high. However, labral tears are often associated with other forms of pathology such as hip dyplasia or hip impingement. The overall rate of success of labral debridement is associated with the underlying diagnosis and status of the articular cartilage of the joint.


• How long would I be in the hospital?
The procedure is usually performed as an outpatient. Most patients are kept on crutches for one to two weeks after the surgery. If reshaping of the femoral head is performed, crutches are continued for 6 weeks to allow the bone to gain adequate strength in the region of the bone removal.


• When could I go back to work?
Most patients can return to work in about 3 weeks