Hip arthroscopy

Hip arthroscopy refers to the viewing of the interior of the acetabulofemoral (hip) joint through an arthroscope and the treatment of hip pathology through a minimally invasive approach. This technique is sometimes used to help in the treatment of various joint disorders and has gained popularity because of the small incisions used and shorter recovery times when compared with conventional surgical techniques (sometimes referred to as 'open surgery'). Hip arthroscopy was not feasible until recently, new technology in both the tools used and the ability to distract the hip joint has led to a recent surge in the ability to do hip arthroscopy and the popularity of it. Hip arthroscopy refers to the viewing of the interior of the acetabulofemoral (hip) joint through an arthroscope and the treatment of hip pathology through a minimally invasive approach. This technique is sometimes used to help in the treatment of various joint disorders and has gained popularity because of the small incisions used and shorter recovery times when compared with conventional surgical techniques (sometimes referred to as 'open surgery'). Hip arthroscopy was not feasible until recently, new technology in both the tools used and the ability to distract the hip joint has led to a recent surge in the ability to do hip arthroscopy and the popularity of it. The first man to describe the use of an arthroscope to see inside a joint was Severin Nordentoft, from Denmark, in 1912. Since that time, the field of arthroscopy has evolved to encompass diagnostic and therapeutic procedures to many joints. Technical advances in instrument manufacture and optical technologies have, in part, made it possible for the surgeon to gain access to reliable views of increasingly smaller joint spaces. Now, there is an International Society for Hip Arthroscopy (ISHA), comprising some of the leading hip arthroscopy specialists in the world. Arthroscopic techniques have become an increasingly popular method of treating hip conditions. Although first described in the 1970s, since approximately 2000 the indications and numbers of hip arthroscopic procedures performed worldwide have expanded widely. This is due mainly to the identification of pathological conditions such as femoroacetabular impingement (FAI) and tears of the acetabular labrum. The concept of FAI was first described by Smith-Petersen. However, modern diagnosis and treatment of FAI was pioneered by Ganz in 2003, who initially advocated the use of an open surgical dislocation technique for treatment of intra-articular pathology. This involved the use of the 'trochanteric flip' approach to gain access to the hip joint. This is an extensive approach, needing an often large incision over the side of the hip, with the detachment of the greater trochanter of the femur and its attached musculature to gain access to the joint. By using this approach, the ball of the hip joint can be rotated out of the socket (termed 'surgical dislocation'), giving 360-degree access to the whole joint. This approach, although considered generally safe, carries with it inherent risks, which is the case with all large incision surgery. The risks of infection and blood clots are always present, and Ganz and his colleagues cite complications such as heterotopic ossification (new bone formation around the hip), nerve injuries, failure of the greater trochanter to heal back properly, persistent pain following the formation of scar tissue (adhesions) in the hip joint, and a small risk of damage of the blood supply to the femoral head. The patient usually needs to stay in hospital for a few days, and the post-operative rehabilitation after such extensive surgery can be prolonged. As a result, surgeons have looked to use the arthroscope more extensively in the hip joint in an attempt to avoid the possible pitfalls of large, open surgery. The perceived advantages of this are the avoidance of large scars, decreased blood loss, faster recovery periods and less pain. Hip arthroscopy can be performed as an outpatient procedure (i.e. no need to stay in hospital overnight). Hip arthroscopy was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint itself. The most common indication is for the treatment of FAI (femoral acetabular impingement) and its associated pathologies such as labral tears and cartilage abnormalities, among others (see Table 1).