Richard Villar - World-recognised hip and knee surgeon

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Hip Arthroscopy - Indications

 

In the early days of hip arthroscopy, many procedures were performed simply to find out what was happening inside the hip joint. X-Rays do not allow one to see damaged soft tissues and MR scanning was in its infancy. Even now, despite the use of specialist scans, it is still not always possible to say what is going on within a hip joint unless hip arthroscopy is undertaken.

 

However, in broad overview, the indications for hip arthroscopy are many and varied but perhaps may be outlined as follows:

 

1.

Impingement

2.

Articular cartilage (gristle) problems

3.

Labral injuries

4.

Loose body retrieval

5.

Synovitis (inflamed hip lining)

6.

Torn ligamentum teres (major hip ligament tear)

7.

Hip instability

8.

Infection

9.

Painful joint replacement or resurfacing

10.

Avascular necrosis (blood supply problem to ball of hip joint)

11.

Muscle injuries around the hip (gluteus medius, gluteus minimus, gluteus maximus, rectus femoris)

12.

Trochanteric bursitis (pain on the outside of the hip – usually in females)

13.

Nerve release around the hip

14.

Snapping hip

15.

Iliopsoas tendonitis

16.

Hip tumours

17.

Hip fracture or hip dislocation

18.

Foreign body retrieval (e.g. bullet)

19.

Osteoarthritis

20.

Diagnostic hip arthroscopy

 

This list is not exhaustive and it should be remembered that the results of hip arthroscopy depend in large part on the condition which is being treated. For example, we know that 80% of patients can feel better after hip arthroscopic surgery for impingement. However, this figure can drop as low as 40% if hip arthroscopy is undertaken for osteoarthritis. Please also remember that there is no operation on the planet that can offer a 100% chance of success.

 

For interest, we have also included some arthroscopic images of selected conditions for you to peruse.

 

Torn Acetabular Labrum   Iliopsoas Tendonitis

A torn acetabular labrum

  

Iliopsoas tendonitis
     
Ruptured Ligamentum Teres   Large impingement lesion

Ruptured ligamentum teres

  

Large impingement lesion
     
Cyst trying to burst out of the labrum (intralabral cyst)   Lipoma (a benign tumour) of the hip joint

Cyst trying to burst out of the labrum (intralabral cyst)

  

Lipoma (a benign tumour) of the hip joint
     
Removing a loose body from the hip   Osteoarthritis of the hip

Removing a loose body from the hip

  

Osteoarthritis of the hip – the large lump of bone to the right was dramatically reducing hip movement until it was removed arthroscopically
     
Fracture of the acetabulum   A bullet in the hip!

Fracture of the acetabulum (hip socket)

  

A bullet in the hip!
     
Performing a microfracture of an area of articular cartilage (gristle) loss   Dealing with pincer impingement – burring away part of the acetabular margin

Performing a microfracture of an area of articular cartilage (gristle) loss

  

Dealing with pincer impingement – burring away part of the acetabular margin
     
Synovitis – inflammation of the hip lining   Bare bone exposed due to osteoarthritis

Synovitis – inflammation of the hip lining

  

Bare bone exposed due to osteoarthritis
     
X-Ray (image intensifier) view of hip arthroscopic surgery in progress   An area of gristle loss (osteochondral fracture) of the femoral head (hip ball)

X-Ray (image intensifier) view of hip arthroscopic surgery in progress

  

An area of gristle loss (osteochondral fracture) of the femoral head (hip ball)
     
Removing osteoarthritis (central osteophyte) from the acetabulum (hip socket)   Repairing the labrum

Removing osteoarthritis (central osteophyte) from the acetabulum (hip socket)

  

Repairing the labrum