Minimally Invasive Hip Arthroscopic Procedure

Arthroscopic techniques have revolutionized surgery. Taken from the Latin words "arthros" (joint) and "scope" (to look inside), arthroscopy allows physicians to make a tiny incision and look inside the joint, rather than the large, more invasive cuts once required. Historically the physician had to cut through skin and tissue and dislocate the joint to get at problems in the joint, causing considerable damage in some cases.

Now, with just a tiny puncture wound, the surgeon can insert a pencil-sized optical device into the knee or hip joint. The image from the miniature television camera attached to the arthroscope is projected onto a large video monitor in the operating room, showing the surgeon exactly where to go to correct problems in the joint - or in some cases, to perform the corrective procedures.

At first, the view isn't quite so clear. The acidic, deteriorated joint fluid often clouds the picture. But as clear salt water is pumped into the joint, clearing out the old, destructive fluid, much like an oil change in your car. Often this cleansing, called lavage, is enough to provide relief for some patients. However, many also need to have the rough edges that scrape and damage cartilage removed as well.


Hip Impingement

Normally,  the round head at the top of the femur bone (the thigh bone) normally glides smoothly in the hip socket. If the top of the femur is not round (cam impingement) or if the front edge of the socket is too prominent (pincer impingement), then the smooth motion is disrupted. This condition is called hip impingement or femoro acetabular impingement (FAI).

 

Loose Bodies

Healthy cartilage has a smooth, billiard ball-like surface. As degenerative arthritis progresses, turning that smooth surface into a cracking surface, some of the cracks break off and float unattached in the joint. Those fragments are called loose bodies; they can become an annoyance that leads to trouble.

Loose bodies can cause a "catching" in the joint. They can also scratch and damage the smooth areas of the joint. Some doctors like to remove them as soon as they are identified or before they ruin what might otherwise still be a fairly good hip joint.

Before arthroscopy, people had to live with those loose bodies in their hip joints until the pain or limitation became so severe that removal with invasive procedure became the only option.

 

Torn Labrum

If your hip pops or locks (freezes in position) you may have a torn labrum. The labrum is a rim of fibrocartilage that runs completely around the acetabulum (the socket side of the hip joint), effectively deepening the socket and increasing the capture of the socket onto the ball. Some specialists believe this may be one of the causes for arthritic deterioration of the hip.

When a labrum tears and flips into the joint, it starts to scratch the surface. But with arthroscopic surgery, the physician can sometimes trim the labrum before it scratches a hole through the surface of the cartilage, stopping the hip's deterioration before it begins, and maybe even avoiding a hip replacement.

 

Synovitis

When the synovial lining of the hip joint is so inflamed it causes disabling pain, it may have to be removed, called a synovectomy. A complete synovectomy isn't possible through an arthroscope, but when the accessible portions of the synovium are removed, patients may feel significant improvement.

 

Hip Arthroscopic Surgery

Once your physician has determined that you are a good candidate for surgery, you'll pass through admissions and pre-op and be taken into the operating room (OR) by the nurses and the anesthesiologist.

You will decide which kind of anesthesia you want: an epidural, a spinal or a general. Your surgeon will confirm your choice with the anesthesiologist who will then administer it.

You'll be given intravenous (IV) antibiotics to guard against infection. The leg that is to be scoped is treated with an antiseptic solution and draped so that only the area of the hip joint and the leg involved is exposed. The rest of the body is covered.

Your doctor will use special instruments that allow him to make a path through the tissues into the joint in as gentle a way as possible. Once he has cleaned away the inflamed material, and pulled aside the other tissue, your doctor will then be able to work on any loose bodies in the joint and smooth any rough spots.

Once that's finished, the instruments will be removed and the puncture wounds will be sewed up. Although you'll spend only about a half hour in the OR., you'll spend as much time in the recovery room as any other patient following major surgery in order for the anesthesia to wear off. But chances are good, you'll go home the same day.

 

Recovery from Arthroscopy

Research has shown that proper use of exercise in the recovery process speeds healing; lack of it during the early stages may result in permanent disability, however. You need to move, but use comfort as your guide.

Typically you'll be offered crutches for comfort; it's up to you how much to use them. Though you can get up and walk around immediately, you'll be encouraged to take it easy for a few days. You may be given a cooling unit to take home, which works just like ice packs around the wound. After a few days, you'll return to your doctor's office to change the bandage.

Do the land exercises you've been assigned gently, as soon as pain allows. About a week after surgery, the stitches will be removed and a day or two later, you can get in the pool with no restrictions. Take your hip through its complete range of motion, if possible. If you feel pain, work only to our level of tolerance. 

A Window of Opportunity

After a hip arthroscopy, you should feel significantly better within a week or two. The inflamed tissues and destructive fluids have been removed - your pain should be greatly reduced.

Now you need to work the joint so it can become as healthy as possible during the brief window of opportunity - this is when your pool and land programs will make the muscles around the joint stronger, before your body recreates the corrosive fluids that caused your problems in the first place. This is the time to force the joint to become more limber and to achieve a healthy range of motion, so you can reverse the vicious cycle of loss of function.

The stronger your muscles, the more they can act like springs or shock absorbers for your hip and the less the weight-bearing surfaces inside the joint will pound upon each other. Then, when the arthritic process in your hip begins to create corrosive fluid again, you'll be able to fight back with muscular strength and flexibility. You may need further surgery, but arthroscopy can be a stopgap measure to keep you functioning for years without it. Use your window of opportunity wisely.