Hip Arthroscopy

Hip arthroscopy is a keyhole surgery of the hip for certain hip joint conditions and is usually performed under a general anaesthetic. There are only a small number of hip arthroscopy surgeons in Australia, and, as it is a developing area of treatment, they have undergone extensive training to perform this procedure.

Surgery has proven to facilitate a speedy return to sporting activities for both recreational and elite athletes. Many of these conditions were previously unrecognised and thus left untreated. But recent advances in hip arthroscopy and MRI scans have illuminated many sources of joint abnormalities that result in a series of disabling symptoms.

There are several reasons why a hip arthroscopy may be needed:

Femoroacetabular Impingement (FAI)

This occurs when hip bones are abnormally shaped and grate against each other causing discomfort and swelling. This can happen in 2 instances:

1. Abnormal morphology of the hip: When hip bones collide unevenly.
2. Normal anatomy and hip morphology: This is common when there has been excessive range of motion around the hip – especially in young athletes.

FAI can lead to osteoarthritis of the hip by damaging joint surface cartilage or labral. Impingement can be either CAM impingement or PINCER type.

CAM This symptom comes from the Dutch word ‘cog’ and actually describes the femoral head and neck relationship which may not be round or spherical as it should be, causing abrasion.

Due to this abnormal configuration the head jams on the acetabular rim (cup) during certain movements or positions, leading to joint cartilage damage and labral tears. This causes impingement that creates pain or discomfort in the groin. This can quite easily progress to osteoarthritis if left untreated. It is best to see a hip arthroscopy surgeon early.

Pincer type lesions:

This occurs when the socket (Acetabulum) has too much bone. When the hip moves in certain directions, the labral cartilage is pinched between the rim and the femoral head/neck junction. This coverage is usually over the top-front part of the rim or socket.

Pincer impingement can be due to:

1. Socket Retroversion – Facing back of the socket
2. Protrusio –Femoral head sits deep into the socket
3. Profunda – Deep Socket leading to impingement

Alpha Angle in Hip Impingement

This is used to determine the extent of the CAM lesion and what treatment steps are required. This can be measured using X-rays, CT scans or an MRI. Your specialist hip arthroscopy surgeon needs to rule out other conditions that can mimic the effects of hip impingement.

Conditions that can mimic hip impingement include:

• Back problems, including lumbar and spine conditions
• Sacroiliac conditions
• Iliac apophysitis
• Iliopsoas tendonitis
• Trochanteric bursitis
• Hip dysplasia
• Sprain of the abductor muscles
• Hamstring tendinitis

Sporting Activities commonly related to Hip Impingement:

• AFL Footy
• Rugby (League and Union)
• Soccer
• Dancing (Ballet/acrobatics)
• Gymnastics
• Hockey
• Cycling
• Martial Arts
• Gymn work including deep squats
• Surfing
• Tennis
• Golf
• Rowing water sports

How did I get FAI?

This is still somewhat unclear to hip arthroscopy surgeons. Whether it was present at birth or developed later in life still remains a mystery, although genetics and environmental factors do play a role. Impingement is seen most often in male athletes.

Will I have Arthritis in the Hip if I have Impingement?

Even with clear results from X-rays and MRI scans it is possible to have loss of hip joint cartilage.

Does a Normal MRI mean I don’t have impingement?

An experienced hip arthroscopy surgeon will know exactly what to look for in scans and also take into account your medical history and regular activities that may have led to an impingement. If there are serious signs of problems, a hip arthroscopy may be needed.

Can my other normal Hip have FAI?

Yes this is possible.

Which is Better for FAI, MRI or CT?

Both are good investigative tools for diagnosis of FAI. But CT scans involve a large amount of radiation especially with 3D-CT scanning. An MRI can give sufficient information for FAI if surgery is planned.

What are the Treatment Options for FAI?

Nonsurgical treatment is an option; this requires activity modification, and improving hip strength through a series of exercises. Surgical options involve hip arthroscopy and shaving away the bump or CAM. If there is a labral tear or pincer type lesion this can be all addressed in the one procedure.

If there are areas of cartilage loss then microfracture drilling can be performed to cause new cartilage growth in that area.

What are the surgical risks with FAI surgery?

• local infection
• local haematoma – bleeding
• swelling of the thigh
• fracture neck of femur
• avascular necrosis of hip
• instability
• scarring
• nerve damage (femoral, sciatic, superficial nerves, pudendal
• Groin bruising
• Blood clots
• Heterotopic ossifications

Labral Tear:

Groin pain and mechanical symptoms of the hip like painful catching or clicking could be due to a labral tear. Labrum is the band of tough cartilage that surrounds the rim of the Acetabulum (hip socket). It provides stability to the hip joint. This could be either trimmed or repaired depending on the pathology. A Hip Arthroscopy can be performed to repair the labrum and restore flexibility.

Snapping Hip:

This is a hip syndrome where a snapping sound can be heard, followed by uncomfortable movement when you walk, run, dance, climb stairs, get up from a chair or play sports.

The cause is usually mechanical, such as when an abnormally shaped bone comes in contact with and constricts normal muscle or tendon movements.

The causes include:

• Iliotibial band passes over the greater trochanter
• Iliopsoas tendon passing over iliopectineal line or femoral head
• Iliopsoas bursa
• Rectus femoris passes over the femoral head (aspherical)
• Loose body inside the hip joint
• Labral tears, bony prominences of the femoral head
• Fat Pad, synovial folds.

Treatment by a specialist hip arthroscopy surgeon can address these issues after an expert consultation that takes into account a patient’s history, an examination and thorough scans.

Hip Arthroscopy can also be performed for a variety of other conditions such as:

• Hip joint Infection
• Ligamentumteres injuries
  • Iliopsoas bursitis
  • Removal of loose bodies
• Cartilage lesions in the femoral head or socket

Hip arthroscopy may also be indicated for diagnosis and treatment of impingement after certain hip replacements, psoas tendon irritations and sporting related injury concerns.

For more information on how a hip arthroscopy surgeon can help relieve your pain, visit www.orthoinfo.aaos.org

• DO I Need Surgery?