Arthroscopy of the hip joint is becoming increasingly important in orthopedics, after endoscopies of the knee, shoulder and ankle joints have long been standard. In many cases, this can avoid or at least postpone the insertion of an artificial joint.
What is hip arthroscopy?
During hip arthroscopy, special mini-instruments are inserted into the hip joint through small incisions in order to identify and correct the causes of osteoarthritis in time. Hip arthroscopy is an endoscopy of the hip joint and is one of the minimally invasive keyhole surgical techniques. During hip arthroscopy, special mini-instruments are inserted into the hip joint through small incisions in order to be able to detect and correct the causes of osteoarthritis in time, before the joint becomes stiff. Hip arthroscopy is thus a prophylactic procedure for the preservation of the hip joint and offers the advantage of being a simultaneous examination and therapy procedure. In order to be able to stop osteoarthritis, early diagnosis is important, because only if the wear and tear has not yet progressed can it even be considered as a surgical procedure.
Function, effect and goals
Hip arthroscopy is usually performed for injuries and wear and tear to the hip when conservative treatment methods do not help and other diagnostic methods such as X-rays, MRI and CT are not conclusive enough. An experienced practitioner can usually detect wear-related bone changes on an X-ray that pinch the hip joint and wear it out through abrasion. This entrapment is called impingement in medical jargon. There are two forms of hip impingement:
In pincer or bite impingement, the femoral head sits particularly deep in the acetabulum and regularly impacts the acetabular rim when the body moves. As a result, the cartilage takes damage and the joint can only be moved with pain. In cam or camshaft impingement, the femoral head, which normally narrows into the neck of the femur, has a bulge that hits and injures the acetabulum during intense movements. Both forms can be successfully treated by hip arthroscopy and restore function to the joint. Hip arthroscopy is always performed as an inpatient procedure and usually under general anesthesia, because the leg must be extended about 1 – 2 cm for this examination in order to have a sufficient view of the joint. The patient is placed on an extension table and the examination is performed in the lateral or supine position. A special arthroscope is inserted into the joint through a small incision, while a video documents all surgical steps. Additional arthroscopy instruments can be inserted through other small incisions for tissue removal and bone removal, if needed. Patients must remain in the hospital for 2 to 3 days after the procedure because the leg and hip must be positioned gently. Full weight-bearing on the leg is only allowed after about 2 more weeks. Accompanying physiotherapy can promote mobility after the procedure. Since hip arthroscopy is a technically complex procedure and requires well-trained personnel, only a few medical centers have specialized in hip arthroscopy. It is primarily suitable for athletic people in whom wear and tear is not advanced. The goal of hip arthroscopy is to restore full range of motion to the joint, thereby avoiding the need for an artificial hip joint. It is a good procedure to stop degenerative changes in the hip joint, but this is only successful with early diagnosis and treatment.
Risks, side effects, and hazards
Even though hip arthroscopy has become increasingly important in recent years alongside long-term established arthroplasty, and minimally invasive surgical procedures are generally considered gentler, the risks and benefits of this surgical technique must be carefully weighed. In the euphoria of avoiding an artificial hip joint, patients often engage in hip arthroplasty without sufficient knowledge of the risks and side effects. In particular, the traction on the leg that is necessary to expose the view of the joint carries a risk that should not be underestimated, because it can damage nerves.Some patients experience temporary numbness of the thigh after hip endoscopy, others experience paralysis or persistent numbness of the leg, and there are even cases of fracture of the neck of the femur. Many patients are left with symptoms. Hip arthroscopy has only been practiced for a few years, and there is a lack of long-term studies to determine whether it is truly capable of improving osteoarthritis in the long term and avoiding the need for an artificial hip joint. In the long-term experience of arthroscopy on the knee joint, there has been no evidence to show that the procedure produces a permanent improvement. And it is important to keep in mind that the knee joint is much easier to access during arthroscopy than the hip joint. Therefore, physicians should carefully examine for which patients arthroscopy really achieves an improvement and also explain the risks to them. It only makes sense in exceptional cases where it is possible to assess in detail in advance which complaints can be improved. In the case of arthrosis that regularly causes pain during movements, an artificial hip joint is still the more sensible choice. In summary, when risks and benefits are weighed, hip arthroscopy can be a real alternative for patients with hip complaints in whom conservative therapies do not help sufficiently, but in whom advanced wear has not yet occurred.