Hip arthroscopy or “keyhole” hip surgery involves operating deep within the hip through tiny “keyhole” incisions – one for a fine fibreoptic camera and 1 or 2 other keyhole incisions through which instruments are carefully passed into the hip joint.
This is a relatively new field of Orthopaedic Surgery that has been made possible within the last decade due to advances in surgical instrumentation.
These techniques have revolutionized the treatment of disorders such as femoroacetabular impingement (FAI) and labral tears.
Problems within the hip joint that could not be reached previously, or accessed only through open incisions, can now often be successfully treated arthroscopically and the indications for hip arthroscopy continue to be developed.
Mr Freedman undertook an international fellowship at University Hospital Coventry and Warwickshire with world renowned hip arthroscopy surgeon, Professor Damian Griffin. Mr Freedman then gained futher experience in hip arthroscopy in Paris. Mr Freedman will be able to advise if hip arthroscopy is appropriate for your condition.
Current indications for hip arthroscopy include:
- Acetabular labral tears
- Cartilage tears
- Reshaping for Femoral shape problems (“CAM” lesions)
- Acetabular Pincer (overcovering of the socket)
- Ligamentum teres injuries
- Loose Bodies
- Snapping hip syndrome (tendons flicking over the hip)
- Iliopsoas bursitis
- Other indications may include assessment of osteonecrosis of the femoral head (loss of blood supply), rheumatoid arthritis, gout and infection.
- Hip arthroscopy can sometimes also be used to alleviate the symptoms of mild-to-moderate hip osteoarthritis with associated mechanical symptoms.
Hip arthroscopy is technically challenging. It should be performed by a surgeon who is appropriately trained in the technique.
What is the labrum of the hip?
The labrum is a ring of flexible cartilage that sits on rim of the bony socket of the hip joint. The labrum has many functions including shock absorption, joint lubrication, pressure distribution, and aiding in stability of the hip joint by deepening the socket.
What is a labral tear?
The labrum of the hip may tear, causing hip pain and instability.
There are two general types of hip labral tears: degenerative tears and traumatic injuries.
A degenerative tear occurs as a result of repetitive use and activity. This type of tear is often associated with femoracetabular impingement (FAI). As the hip flexes (bends up) and rotates the labrum may be pinched and can becomes shredded. Patients are typically active, often taking part in sports such as running, kick-boxing, mountain biking and horse riding
A traumatic hip labral tear is usually an acute injury as a result of a sports injury, fall, or accident. The pattern of injury is commonly associated with sudden, twisting manoeuvres that cause immediate pain in the hip.
Patients with a labral tear typically present with deep sharp groin pain, often during full hip bending.
There may be an associated deep click, which can be either due to the torn labrum itself or due to an inflamed tendon running over the front of the hip. If the condition has been present for some time, there may also be inflammation of the tissues surrounding the hip such as the outer hip (trochanteric bursitis), the groin muscles (adductor tendonitis) or inflammation of tendons in front of the hip.
As the labrum is made of cartilage it cannot be seen on plain x-rays. Instead, a special scan known as an MRI (Magnetic Resonance Image) which is able to look at soft tissues is required. Mr Freedman may request an enhanced MRI known as Magnetic Resonance Arthrography (MRA) which involves injecting injecting dye into the hip joint prior to the scan.
The labrum has poor bloody supply and therefore often not heal or reattach on it’s own. However, if a patient is not fit surgery the symptoms of a labral tear can usually be treated with physiotherapy, painkillers, anti-inflammatory drugs and activity modification.
However, if a patient is suitable for surgery, key-hole hip surgery (hip arthroscopy) can be used to repair the labral tear. Specialist rehabilitation is required after surgery.
Labral Tear Surgical Treatment
Suffering from a Labral tear? The surgical treatment of choice is hip arthroscopy. This allows access to both the true hip joint itself and the front of the femoral head where the bony abnormality that caused the tear is often located.
Many patients do not have a frank tear of the labrum itself but rather the labrum is peeled back from the acetabular rim.
In those patients where there is a gross tear, the tear can often be is repaired with special stitches or glue. Occasionally the labrum is frayed and is simply debrided back until it is stable.
If there is an underlying bony abnormality on either the femoral head or the bony socket then that can also addressed during the Labral tear surgery. This is technically difficult surgery but can achieve excellent results if carried out correctly and on the right patient. Occasionally, the bony deformity may be so large that an adequate bony reshaping is not possible using key-hole surgical techniques. In these cases the Labral tear operation is done using an open technique and the labral tear can be addressed at the same time. The advantages and disadvantages of the various Labral tear treatment options will be discussed at the time of your consultation with Mr Freedman.
Most patients who have hip arthroscopy by Mr Freedman will be admitted overnight so that they can participate in inpatient physiotherapy the next day.
Patients will generally go home the day after surgery.
Depending on the condition treated, patients will be advised to expect a 6 week to 3 month recovery period but are usually able to return to office type work within two weeks of surgery.