When can and should arthroscopic surgery be done for hip disorders? In this in-depth review of arthroscopic hip surgery, orthopedic surgeons from Northwestern University in Chicago, Illinois offer their insights, opinions, and recent research evidence for treatment decisions regarding a variety of hip problems.
Anyone with hip pain that doesn’t go away with a little stretching, movement, or change in position will need a thorough, systematic patient history and physical examination. Posture, walking pattern, hip range-of-motion, and strength will be evaluated. Special tests to look for specific problems (e.g., labral tears, femoroacetabular or psoas impingement, muscle tightness, instability, bursitis).
Imaging studies such as X-rays will be used to rule out bone fractures and/or detect joint changes due to arthritic degenerative disease. For each of these potential problems, the authors provide a detailed discussion of who is at greatest risk, what the clinical presentation might be, and the choices for surgical management when conservative (nonoperative) care is not successful.
Tables outlining views taken on X-rays and MRIs provide the surgeon with an idea of what to evaluate, what is considered normal versus abnormal, and signs of bony abnormality. Important factors to assess when viewing X-rays when evaluating patients with femoroacetabular impingement (FAI) are also presented in a special table. X-ray examples are included to give a visual understanding of this condition.
Once an accurate diagnosis has been made, then the decision-making process begins in planning the most appropriate and effective treatment. The authors confine their discussion to problems that require arthroscopic hip surgery.
This can include painful labral tears, femoroacetabular impingement (FAI), loose bodies in the joint (e.g., fragment of bone or cartilage), ruptured ligaments, psoas impingement, and snapping hip syndrome. Every effort is made to look for (and find!) secondary or associated injuries that might be present along with the primary condition. This could affect tendon, ligaments, bone, or joint capsule.
Details of patient position during surgery, location of portals (area where arthroscope is inserted into the skin and through the soft tissue to the joint), and surgical technique are provided for each of the conditions mentioned. Once again, the authors provide drawings and patient photos taken during surgery to show exactly what they are describing.
Postoperative rehabilitation, possible complications, and outcomes from long-term studies and systematic reviews make up the final one-third of the article. Now that minimally invasive arthroscopic techniques and tools are available, more and more hip reconstructive surgeries can be done this way. When patients are carefully selected (taking age and severity of the problem into consideration), results are good to excellent with very low complication rates.