M.P. Muldoon, M. D.
Orthopedic Medical Group of San Diego
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Hip joint is much less accessible than other
joints
More technically difficult-need specialized
equipment and expertise
Conditions warranting its use are rarer
Use and indications are emerging
◦ Minimally invasive means of seeing inside the hip
joint without cutting muscles or using big
incisions much like is done in the knee or
shoulder
◦ First done in 1930s but re-introduced in late
1980s by Dr. Glick of San Francisco
◦ Techniques and indications refined in mid-late
90s allowing more predictable results
◦ Even greater interest in last 4 years because of
treatment of high profile athletes and improved
techniques
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Indications
◦ Remove loose bodies
such as cartilage or
bone from hip joint
as on right
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Indications
◦ Investigate hip joint
for sources of
mechanical pain and
address them
surgically
◦ To help diagnose hip
pain sources when
other test do not
reveal source
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Indications
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The treatment of Femoral Acetabular Impingement
Snapping Hip Syndromes
Recalcitrant Trochanteric Bursitis
Repair or debridement of Labral tears
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Indications
◦ As an adjunct to other procedures in order to rule
out problems inside the hip joint or allow other
procedures to be performed less invasively
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Contraindications (reasons not to do hip
arthroscopy)
◦ Advanced arthritis
◦ Arthritis without mechanical symptoms (catching,
locking)
◦ Very stiff hips
◦ Fresh fractures or dislocations
◦ Surgical problems in which opening the hip joint
is not necessary
◦ Obesity…Sometimes the instruments are not long
enough
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In order to view the hip
joint without scuffing
the cartilage it is
necessary to use a
traction device to open
up the hip joint and
allow instruments to
be introduced
General or spinal
anesthesia is preferred
to allow for complete
muscle relaxation
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Special instruments
have been designed
to aid entry into hip
joint and to remove
damaged tissues
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In Many cases
surgery can be
performed through
two or three small
incisions
In lower picture
patient is draped
and flouroscopy
unit in position to
guide procedure
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29 year old woman
with pain and
catching after
intense period of
exercise 8 months
previously
Xrays were normal
but the MRI
arthrogram showed
a tear in the labrum
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At surgery a torn
labrum was
diagnosed and
excised
Patient was back to
full activities at 3
months
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Surgery is generally done as outpatient but
more complex surgeries with longer
anesthetics may stay overnight
The hip is injected with long acting
anesthetic to ease transition to home.
Anti-inflammatories (NSAIDS) are
prescribed for the first three weeks to aid in
recovery with narcotics available for pain
that does not respond to rest, ice and
NSAIDS.
In Many cases you will wake up with a
motion machine - CPM which helps with
pain and early mobilization
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Crutches for several days to weeks until
strength comes back –Most patients can
weight bear as tolerated
Most severe pain is experienced in first 4872 hrs
Sutures are removed at two to three weeks
Sense of fullness that persists up to 6-8
weeks
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Pain at the incision sites is similar to a bruise
in intensity
Activity is progressed slowly with emphasis
on low impact exercises for the first three
months
In more complex cases for FAI - directed
physiotherapy using a specialized
rehabilitation protocol is employed
Complete recovery may take 6-9 months
◦ Temporary Nerve injuries can occur from traction on
sciatic nerve or excess pressure from boot on top of
foot. Most of these are markedly improved within a
week but can last several weeks to months
◦ Infection or significant bleeding is extremely rare.
◦ Instruments can break in the hip joint and may
require a bigger incision for removal
◦ The surgery may not improve the condition and can
occasionally make an arthritic hip worse
◦ Hips can become stiffer and actually form bone in soft
tissues known as Heterotopic ossification…this can be
prevented by use of NSAIDS for 3 weeks postop
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Summary
◦ Hip arthroscopy provides a minimally invasive
approach to dealing with many sources of hip pain
that are unresponsive to other treatments
◦ There is a low complication rate and a relatively
rapid recovery after surgery