In comparison to the rapid development of minimally invasive surgery on the knee and shoulder joint, arthroscopy on the hip joint has developed only slowly. There are many reasons for this. Many symptoms were not recognized and therefore remained untreated. The development of special instruments for hip arthroscopy and the improved quality of MRI technology has brought us great progress. Indications for an arthroscopic hip operation are patients with chronic hip joint pains caused by lesions in the labrum-capsule complex and bony structures (impingement) on the neck of the limb. Other indications are cartilage damage on the head and socket, beginning arthroses, and free-floating pieces of cartilage.
The head of the hip and the socket form the central anatomic structures of the hip joint. Once extended, the central area of the hip joint together with the head of the femur and the socket can best be assessed and treated at the same time. Degenerative damage to the joint surfaces, inflammations of the interior surface of the joint, and free-floating pieces of cartilage can be diagnosed. The head of the femur and the edge of the socket (peripheral part of the joint) can be well visualized without extension. A joint lip (labrum) is located on the edge of the socket; it is very important for optimal joint functioning.
Clinic and diagnosis
An exact medical history and examination supplemented by x-rays and an MRI are indispensable for an exact diagnosis. Assessment of the walking profile, together with an examination of passive and active movement of the hip joint, is necessary. Painful bending, adduction, and internal rotation give evidence of pathology on the edge of the socket (damage to the labrum) or of bony protuberances on the neck of the femur. X-ray diagnostics as a basic examination show us traumatic and degenerative damage to the head, neck, and socket. MRI imaging conducted with a contrast medium gives us reliable evidence of damage to the cartilage and defects in the labrum.
Arthroscopy of the hip joint is a reasonable treatment for patients with blockages, constrictions, and undefined pains in the groin.
The operation takes place under full anesthesia and is connected with an inpatient stay of several days. An optical device and instruments are inserted into the joint through several small skin incisions. The head of the hip is drawn 1-2 cm out of the socket onto what is called an extension table in order to get a good overview. Simultaneous assessment and treatment of joint damage (smoothing out the cartilage, boring through and smoothing off defective zones) is possible. Tears on the edge of the socket (damage to the labrum) are smoothed out or refixed. Removal of bony protuberances on the neck of the femur at the edge of the socket improves joint mobility and removes painful constrictions.
After the operation, the patient may immediately put weight on the hip joint of 10-20 kg. Usually crutches are necessary for 2 weeks. Treatments of the cartilage (boring, polishing off) demand a longer period of no weight bearing. Physical therapy and movement exercises on the motorized passive splint begin on the very day of the operation.