Hip arthroscopy

Have you wondered what hip arthroscopy is and what benefits it can bring? Hip arthroscopy is a modern, minimally invasive surgical procedure that allows precise diagnosis and treatment of hip disorders. In this article you will learn how the procedure is performed, its indications and contraindications, and what the rehabilitation process after surgery consists of. If you are struggling with hip pain or are considering this procedure, read on to learn all the relevant information.

Hip Arthroscopy - What Is It?

Hip arthroscopy is an extremely important part of a doctor's arsenal in orthopedic surgery, enabling the diagnosis and treatment of hip conditions in a minimally invasive manner. It represents an innovative and effective procedure in which the use of small incisions allows specialized instruments and a camera to be inserted into the joint, enabling precise assessment of its condition and necessary repair procedures. This minimizes the risk of complications and speeds up the recovery process compared to traditional open surgical methods. 

In the context of preparation for surgery, patients are advised to undergo a thorough diagnosis and receive detailed instructions from the attending physician. Prior to surgery, the patient should adequately prepare physically and mentally, which includes the necessary tests to confirm the feasibility of the procedure and education on the possibilities and effects of the anesthesia used. 

The operation itself, depending on the extent of the damage, can take from 1 to 3 hours, and the patient is most often under local anesthesia. It is worth noting that hip arthroscopy is not only an effective and innovative procedure with rapidly expanding indications, but also an effective way to improve the quality of life of patients struggling with hip ailments.

The method was refined in the late 1980s and early 1990s. Since then, the development of advanced arthroscopic surgery equipment has enabled orthopedic surgeons to treat conditions. that were previously untreatable or that required more invasive, open-ended procedures.

Definition of hip arthroscopy

Arthroscopy is the examination of a joint using an arthroscope, consisting of a narrow, telescopic tube containing a light source and a small camera connected to a monitor. Technological advances related to the development of the tools used and improvements in surgical methods have revolutionized modern hip arthroscopy. There are now options for treating previously misdiagnosed or poorly known lesions.

The minimally invasive nature of this procedure allows it to be used both for diagnostic purposes and for the treatment of various conditions of the hip joint. The purpose of hip arthroscopy is primarily: diagnosis of joint damage, removal of foreign body fragments and repair of damaged tissues. This procedure allows for accurate visualization:

- Bone lesions of the head and acetabulum of the hip joint,

- pontine casing,

- cartilaginous surface,

- synovial membrane,

- Extra-articular periarticular space.

Course of Arthroscopy Procedure

The course of the hip arthroscopy procedure begins with anesthesia of the patient, it is possible to administer both general anesthesia and local anesthesia (regional). The most commonly used and preferred method is local anesthesia, which involves the administration of a drug using a thin needle into the spinal region. This method is less invasive and shortens the period between surgery and discharge home. 

After providing adequate anesthesia, the surgeon makes several small incisions in the skin around the hip joint, usually about 8 mm long, through which he inserts the arthroscope and other necessary surgical instruments.

The procedure usually takes between 1 and 3 hours, depending on the extent of the operation and the complexity of the problem. During the procedure, the surgeon inserts an arthroscope, which transmits images of the inside of the joint to a monitor, allowing precise diagnosis of damage and repair procedures. 

After the operation, the patient is transferred to the recovery room, where he or she spends several hours under observation before being discharged home. Recovery time after hip arthroscopy is usually shorter than after traditional surgeries, so patients return to normal activity more quickly.

Hip Arthroscopy - Indications and Contraindications

Hip arthroscopy is a minimally invasive surgical procedure that allows diagnosis and treatment of various problems of the hip joint. It is performed when non-invasive treatment methods fail or when precise diagnosis of the joint condition is needed. 

With arthroscopy, doctors can accurately assess the condition of the hip joint and take appropriate therapeutic measures, often delaying or avoiding more invasive procedures such as endoprosthesis. A much lower risk of infection, reduced blood loss and a small scar after the procedure are additional advantages of this type of surgical method. 

Most commonly, arthroscopy is recommended for such problems as femoral-acetabular conflict (FAI), damage to the articular cartilage or rim, or the presence of foreign bodies in the joint. The procedure is also used in the diagnosis of vague pain symptoms. The use of hip arthroscopy can significantly increase the precision of diagnosis and the effectiveness of treatment, which has a positive impact on patient prognosis.

Despite the safety of the described method, there are several contraindications that undermine its feasibility and potential effectiveness. 

Indications for Arthroscopy

Hip arthroscopy is recommended for a wide range of cases, most commonly those involving damage to the hip joint that can significantly impede daily function. Not only does it provide a good diagnostic tool, but during it, appropriate repair procedures can be performed immediately. If conservative treatment in the form of rehabilitation or medications or injections does not have the desired effect, arthroscopy may be an apt solution. The most common indications include: femoroacetabular conflict, rim damage or the presence of free bodies. 

Femoral-acetabular conflict (FAI).

FAI, or femoral-acetabular conflict, is a lesion characterized by the altered shape of the bones that make up the hip joint. Due to their mismatch, there is excessive friction, which can lead to damage to adjacent structures such as cartilage and casing

pond. 

The main symptom of the conflict is pain, usually located in the groin, sometimes also in the buttock or lower back exacerbated during or after physical activity and in a position of prolonged sitting. People with FAI may also experience stiffness and decreased range of motion of the painful hip. The pain caused by the conflict is often initially mild and can last for years. However, symptoms can quickly worsen, causing unbearable pain that keeps people from playing sports or other physical activities.

There are three types of FAI:

- CAM: a pathological bony change in the shape of the femoral neck,

Source: https://radiopaedia.org

- PINZER: a pathological bony change in the shape of the acetabular edge,

Source: https://radiopaedia.org/

- Combined or mixed type: characterized by having both of the above-mentioned lesions.

Source: https://radiopaedia.org/

Diagnosis of the femoral-acetabular conflict is made based on the information gathered in the history, as well as the performance of specific diagnostic tests and appropriate imaging studies such as X-ray to confirm the presence of a lesion and MRI to verify whether extra-articular structures such as the rim are also affected.

Damage to the articular rim 

Injuries to the rim are most often caused by sports (soccer, ice hockey, golf) and structural changes in the structure of the hip, such as the femoral-acetabular conflict. The symptoms of the damage depend on both the severity of the damage and its extent.

Most often, patients complain of constant, deeply located pain of a "stabbing" nature. The discomfort may increase during physical activity and travel along the groin or toward the lumbar spine. Other possible symptoms include stiffness, limited range of motion and a "skipping" sensation during movement. 

In the course of diagnosing rim damage, both appropriate functional tests and imaging diagnosis using MRI will be helpful. The use of MRI with the administration of a contrast agent allows a much more precise determination of the possibility of damage.

Source: mayoclinic.org

Free bodies

The presence of free bodies is another of the most common indications for hip arthroscopy. Free bodies are formed as a result of damage to: the soft tissues surrounding the joint, the synovial membrane or the articular surface. The mechanism of formation, as in the case of damage to the rim, can be the result of a single event known to the patient, such as a traffic accident or a moment of physical activity. There is also an internal mechanism resulting from biomechanical changes such as FAI, resulting in the formation of free bodies. 

Patients most often complain of pain in the hip joint with periodic "clicking," "skipping" or "locking" in the joint. The complaints resulting from the presence of free bodies often produce similar symptoms to the cases of rim injury or femoral-acetabular conflict described above. 

Diagnosis of free bodies is difficult. The various origins affecting their composition and the location of the lesion mean that there is no clear indication for evaluation by specific imaging. During diagnosis, we use both X-ray, MRI and CT.

Before surgery, a thorough examination and consultation with a specialist is necessary to assess the condition of the joint and the indications for surgery. This makes it possible to properly prepare the patient for hip arthroscopy and minimize the risk of complications. The advantage of the method used is the reduced risk of infection, minimal scarring and significantly less blood loss during the procedure. 

Contraindications to Arthroscopy

Although hip arthroscopy is a relatively safe procedure, there are some contraindications that may preclude it. The most important contraindications include excessive obesity and severe blood clotting disorders, which can increase the risk of postoperative complications. 

Inflammation, wounds, cuts, and abrasions in the area of the skin where the incision would be made are also contraindications to the procedure because of the risk of spreading infection into the joint.

Other contraindications include advanced osteoarthritis of the hip, which may limit the effectiveness of arthroscopy, and chronic systemic conditions that increase surgical risk. 

In the context of regenerative processes after surgery, it is also recommended to limit smoking. There are studies confirming that smoking slows down the wound healing processes and increases the risk of infection. 

Before deciding to perform a hip arthroscopy, it is essential to thoroughly evaluate and prepare the patient to minimize the risks and increase the chances of a positive surgical outcome.

Hip Arthroscopy - Rehabilitation After Surgery

Rehabilitation after hip arthroscopy is a key part of the recovery process. The rehabilitation process begins the day after surgery and is individually tailored to the patient's needs and the extent of damage found during surgery. Improvement protocols therefore vary in terms of recommendations for weight-bearing of the limb, range of motion, strength training or tips for returning to sports.

In the first few days after surgery, patients usually use crutches, learning to properly load the limb as prescribed. Initially, recommendations include the use of isometric exercises, and then move on to more active forms of therapy. Full loading of the operated limb is introduced gradually, in order to protect and provide the best possible conditions for healing of the tissues undergoing surgery. The total duration of rehabilitation can range from a few weeks to several months, depending on the extent of the surgery and the patient's individual circumstances.

Rehabilitation involves various stages, including minimizing the symptoms of the procedure such as swelling and pain, restoring range of motion (ROM), re-educating gait, gradually strengthening the muscles of the lower extremities, improving coordination and balance, or introducing movements specific to the sport the patient wants to return to.

An early start to rehabilitation is essential for successful healing and a return to full physical function. The ideal time to begin rehabilitation includes the time before surgery. Pre-operative rehabilitation helps to reduce pain and properly educate the patient on how to manage daily life conditions before and after surgery. 

Rehabilitation Recommendations

During rehabilitation after hip arthroscopy, it is important for patients to follow recommendations that help them recover effectively and safely. First of all, overloading the operated limb should be avoided, introducing full load gradually, which allows the joint to better adapt to the new situation. One of the signals of overloading the limb after surgery can be an increase in pain.

Controlling pain and swelling is another key aspect, allowing you to go through the rehabilitation process more comfortably. Regular use of ice packs, as well as appropriate pharmacotherapy, can be helpful in minimizing these symptoms. No less important is cooperation with a physiotherapist, who not only conducts exercises, but also monitors the patient's progress, adjusting the rehabilitation plan to meet the patient's current needs and abilities. This allows patients to gradually return to normal physical activity while avoiding the risk of overloading the hip joint.

Driving after surgery is usually possible about 4 weeks after the day of surgery. Immediately started rehabilitation and constant contact with a physiotherapist allows you to safely, unequivocally confirm the possibility of driving. An absolute contraindication to driving is the period during which strong painkillers are still being taken.

The ability to return to work depends on the extent of the intraoperative procedure and the type of work performed. If you work remotely, you may be able to return to work as early as the first week after surgery. It should be remembered that prolonged sedentary position adversely affects pain in the first phase after surgery. For jobs requiring physical activity, the return to work is significantly prolonged and can take up to 16 weeks.