Hip Arthroscopy

What is a Hip Arthroscopy?

Hip arthroscopy is a surgical procedure performed by Dr. Skendzel, a fellowship trained orthopedic surgeon that specializes in treating labral tears and hip pain. During the surgery, a small camera (called an arthroscope) is inserted into the joint and allows for a clear view of the hip ball and socket joint. This allows Dr. Skendzel to look for causes of hip pain such as labral tears. The camera displays pictures onto a screen, and surgical instruments are guided into your hip to repair the tear.

Anatomy:

The hip is a ball and socket joint. The socket is formed by the acetabulum (part of the pelvic bone), and the ball is formed by the femoral head at the top of the femur (thighbone). The surfaces of the ball and socket are covered by smooth articular cartilage that allows the joint to move easily without friction. The outer portion of the socket (acetabulum) is lined with fibrocartilage ring called the labrum. The labrum acts as a “gasket” to help provide stability to the joint.

Signs and symptoms that you have a labral tear:

  • Groin pain
  • Pain with running or sports activities
  • Popping or catching in your hip
  • Pain getting in and out of a car
  • Trouble walking up and down stairs

Hip Conditions:

There are several medical conditions that can cause hip and groin pain.

Femoroacetabular Impingement (FAI): Occurs when the ball (femoral head) and socket (acetabulum) rub abnormally together causing damage to the hip joint, including the articular cartilage or the fibrocartilage (labrum).

FAI generally occurs in the form of a CAM or PINCER:

pincernormalcam

Cam Impingement: Occurs from a bony spur or prominence on the femoral head/neck junction.

Pincer Impingement: Occurs from an overhanging lip of bone that causes the socket to be too deep.

Labral Tears: Fraying or tearing of the fibrocartilage “gasket” in the hip joint.

Hip Dysplasia: A disorder where the cup of the hip joint is too shallow. This may lead to hip instability or further damage to the labrum.

Osteoarthritis (OA): Joint disease caused from cartilage loss due to aging joints, injury, and obesity. OA symptoms include pain and stiffness. If you are overweight, weight loss may improve OA symptoms.

Who is a Candidate for a Hip Arthroscopy?

Candidates for a hip arthroscopy are active individuals who are limited from participating in daily activities and sports due to groin pain. An ideal surgical patient is motivated and eager to return to a high level of function and is willing to participate in an intensive post-operative rehabilitation program. Patients with hip conditions such as dysplasia or osteoarthritis are usually not recommended for surgery*.

*Patients with hip dysplasia may be a candidate for other forms of surgical treatment, including periacetabular osteotomy (PAO) or non-surgical treatment options.  Dr. Skendzel has published work showing that in patients without osteoarthritis, there is a higher satisfaction level after surgery and a lower risk of conversion to hip replacement.

How is a Labral Tear Diagnosed?

Dr. Skendzel should evaluate active patients with groin pain if there is concern for a labral tear. Examination of the hip, x-rays and sometimes MRI are used to look for FAI deformity and labral tears.

What can I expect after surgery?

Patients will wear a post-operative hip brace until their second post-operative visit with Dr.Skendzel, and crutches are used for a minimum of three weeks. A continuous passive motion machine is used daily for four weeks post-operatively to prevent scar tissue formation. Our team believes in physical therapy after arthroscopic hip surgery to return patients to activities such as hockey, skiing, dance/ballet, and running. For the first 24 hours after surgery you will need an adult caregiver to stay with you to help with medications, movement, encourage fluids, daily activities, and to help you for any possible complications. It is important that the patient has someone available to assist them around the house for a minimum of two weeks.

Numerous studies have shown a very high rate of return to sports and athletic activities after hip arthroscopy.  The biggest risks after hip arthroscopy are associated with the use of traction that is used to safely work within the hip joint.  This included temporary numbness on the thigh and top of the foot; these usually resolve over time.  There are other risks related to anesthesia such as nausea after surgery.

For more information:

    1. The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement.
    2. Management of labral tears of the hip in young patients.
    3. The approach to the evaluation and surgical treatment of mechanical hip pain in the young patient.
    4. Approach to the Patient Evaluation Using Static and Dynamic Hip Pathomechanics.
    5. Update on hip instability.

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