Diseases

Introduction

Hip arthroscopy (Fig.1) is one of the fastest-growing areas in orthopaedic surgery. There are many reasons for this, including a better understanding of the pathophysiology of hip joint pathology, improvements in imaging quality and technology advancements in arthroscopic instrumentation. A detailed history taking and physical examination together with the help of imaging studies including X-ray, CT scan, MRI and MR arthrogram are very important in confirming various hip pathologies.

Initially, hip arthroscopy was an instrument primarily for the diagnosis of intra-articular hip pathology. Now, various techniques are being developed to help perform procedures in and around the hip joint that were previously performed by conventional open methods. It has become a surgical modality capable of delivering great therapeutic results.

Hip joint is tight with limited potential space. Therefore hip distraction (Fig.2, Fig.3) is important to allow insertion of arthroscope and instrument in hip joint. A well padded perineal post (Fig.4) which provide counter-traction is important to protect the nerves around the perineum. It is commonly performed under general anaesthesia.

Labral tear

A hip labral tear (Fig.5) involves the ring of cartilage (labrum) that follows the outside rim of the socket of the hip joint. In addition to cushioning, the labrum acts like a rubber seal to help hold the ball at the top of your thighbone securely within your hip socket.

Athletes who participate in sports such as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.

Labral lesions represent the most common indication for hip arthroscopy. Favorable results can be expected with repair or debridement of painful labral tear (Fig6, Fig7, Fig8, Fig9).

Femoroacetabular impingement (FAI)

FAI occurs when the ball and socket of the hip joint don't fit together properly. The restricted motion damages cartilage and can cause pain and arthritis in young adults.

In some cases, the ball does not fit properly into the socket, we called it CAM lesion (Fig.10). Sometimes, the edge of the socket covers too much of the ball, we called it PINCER lesion (Fig.11). It can also be caused by a combination of these two problems.

Most people with hip impingement experience pain in the groin area during or after flexing the hip, such as when running, jumping or sitting for a long time. You may also have difficulty flexing your hip beyond a right angle.

FAI is increasingly recognized as a factor causative of many labral and articular lesions. It can often be successfully managed with the arthroscope by removing the excessive bone (Fig.12, Fig.13, Fig.14, Fig.15), sometimes reattachment of the labrum is necessary if the excessive bone is over the socket side. However, this is a technically demanding procedure.

Loose body

Removal of symptomatic loose bodies represents the clearest indication for hip arthroscopy. The diagnosis is often evident; the importance of loose body removal is to avoid hip joint damage and improve the mechanical symptom. Arthroscopy offers a much less invasive alternative (Fig.16) to traditional open technique.

Infection

Septic arthritis is a painful infection in a joint. The infection can come from germs that travel through your bloodstream from another part of your body or occur when a penetrating injury delivers germs directly into the joint. It can quickly and severely damage the cartilage and bone within the joint, so prompt treatment is crucial.

Treatment involves surgical draining of the joint and appropriate antibiotics. Arthroscopy (Fig.17) offers a much less invasive alternative to traditional open technique (Fig.18).

Synovectomy or biopsy

Like other joints, there is a role for arthroscopic synovectomy of the hip. Although a complete synovectomy cannot be performed, a generous subtotal synovectomy can be carried out. It also offers s a less invasive alternative to open biopsy of hip joint lesion (Fig.19).