The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The acetabulum is ringed by strong fibrocartilage (the labrum) that forms a gasket around the socket. The ball is formed by the femoral head, which is the upper end of the thighbone (femur). The surfaces of both the ball and socket are covered with a smooth tissue (articular cartilage) that cushions the ends of the bones and enables them to glide across each other with ease. The hip joint is surrounded with synovial membrane, a thin tissue that produces a small amount of fluid to lubricate the cartilage and eliminate nearly all friction during hip movement. The ball and socket are connected by bands of tissue (ligaments) that form the hip capsule and provide stability to the joint.
Arthroscopy is a minimally invasive surgical procedure used by orthopedic surgeons to visualize, diagnose and treat a wide range of problems inside the joint. During hip arthroscopy, a small camera (arthroscope) is inserted into the hip joint and images from inside the hip are displayed on a video monitor. Referring to these images during the procedure enables the orthopaedic surgeon to guide the miniature surgical instruments more precisely.
Because the arthroscope and surgical instruments are thin, very small incisions (cuts) can be used to perform arthroscopic surgery, instead of the larger incisions required for open surgery. This minimally invasive approach results in less pain and joint stiffness, and it often shortens recovery time so patients can return to favorite activities more quickly. Hip arthroscopy has been performed successfully for many years, however, it is not as common as knee or shoulder arthroscopy.
Your orthopaedic surgeon may recommend hip arthroscopy if you have a painful condition that does not respond to nonsurgical treatments such as rest, physical therapy, and medications or injections to reduce inflammation. This procedure may relieve painful symptoms associated with injuries or other problems that damage the labrum, articular cartilage or other soft tissues surrounding the joint. Orthopaedic conditions that frequently can be treated with hip arthroscopy include:
Once the decision to have surgery is made, your orthopaedic surgeon will require some preparations, such as having an evaluation by your primary care physician, or specialists for any chronic medical conditions, to assess your general health before surgery and determine if any problems exist that may interfere with the procedure. If certain health risks are identified, a more extensive evaluation may be required before surgery.
If it is determined that your health is generally good, your hip arthroscopy is likely to be performed on an outpatient basis, which means you will not have to remain in the hospital overnight.
Following surgery, you will remain in the recovery room for 1 to 2 hours before being discharged. You will need someone to drive you home and stay with you, at least the first night.
Pain is a natural part of the healing process but reducing it can help you recover from surgery more quickly. Many types of medicines are available for short-term pain relief after surgery. These include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics. Your physician may use a combination of these medications to improve pain relief and minimize the need for opioids.
Whether you are taking pain medications in over-the-counter or prescription strengths, they must be used carefully. If you are taking them for more than one month, or if you develop reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your physician immediately.
Complications from hip arthroscopy are uncommon. However, with any surgery there are some risks and these vary from person to person. Any surgery in the hip joint carries a small risk of injury to surrounding nerves, blood vessels or the joint itself. Although the traction necessary for the procedure can stretch the nerves and cause numbness, this is usually temporary. Other small risks include infection or blood clots in the legs (deep vein thrombosis). Prior to surgery, your orthopaedic surgeon will explain any potential risks and complications that may be associated with your procedure.
Many people return to full, unrestricted activities after arthroscopy. Your individual recovery will depend on the type of damage that was present in your hip. Lifestyle changes are sometimes necessary to protect the joint, such as switching from a high impact exercise like running, to swimming, cycling or another lower impact activity. These are decisions you will make with the guidance of your surgeon. In cases of severe damage that cannot be completely reversed, the procedure may not be successful.
Arthroscopy has allowed physicians and researchers to gain a better understanding of many hip joint problems. As surgical techniques continue to evolve, hip arthroscopy is expected to play an increasingly important role in the diagnosis and treatment of hip disease.