Orthopedics-Online

Arthroscopy of the hip

General

Arthroscopy of the hip is a surgical operation.

Here, instruments are inserted into the joint using a minimally invasive procedure, with which an assessment and, if necessary, the repair of damaged structures is possible.
Before the introduction of arthroscopy of the hip joint, it was only possible to carry out this work on the hip joint using complex, highly invasive procedures.
The introduction of arthroscopy as a minimally invasive, technical procedure in surgery has therefore brought advantages such as a lower complication rate and faster healing time compared to conventional operations.

Performing an arthroscopy of the hip

An arthroscopy of the hip is done under anesthesia. The patient being treated does not notice anything of the actual operation.

In order to create "space" in the joint, the leg is put under tension and the muscles are stretched.
The surgical instruments are inserted into the joint through small incisions in the skin. In addition to a camera, called an endoscope, which can give the surgeon an overview of his instruments and the joint, different instruments can be introduced through one or more other skin incisions.
With the help of these instruments changes in the joint or the surrounding structures can be detected and corrected immediately.

First, the surgeon will get an overview of the structures of the joint.
These include above all the cartilage of the femoral head and the hip socket.Depending on the damage, the surgeon can now use instruments that can, for example, remove cartilage fibers or eliminate an impingement syndrome of the hip.

The operation is carried out under what is known as an X-ray control. This control can be used to ensure access to the relatively narrow joint space during the operation.

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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Arthroscopy of the hip

Depending on the clinical picture, there are different symptoms, which can be the reason for an arthroscopy.

A common reason for seeing a doctor is hip pain. In fact, almost all diseases that require arthroscopy of the hip are preceded by pain in the hip joint.

If conservative therapy options with medication are no alternative or not successful, in many cases an arthroscopy is carried out. Performing the arthroscopy itself normally takes about one to two hours.
After the surgery, pain medication is given, which can effectively treat the pain that would occur after the surgery.

Since hip arthroscopy is a minimally invasive procedure, the pain should improve within a few days. In principle, however, this always depends on which disease was treated with the aid of arthroscopy. The length of the hospital stay also depends on the disease being treated.
The procedure is usually followed by a two to four day hospital stay.

Prognosis and follow-up treatment of hip osteoarthritis

Physiotherapy and physiotherapy can facilitate regeneration after an arthroscopy.

It is difficult to give a general prognosis because a large number of different diseases can be treated with arthroscopy.

Each disease has a different prognosis, also depending on the individual course of the operation. In general, it is not recommended to put full load on the affected joint after an arthroscopy. For the first seven to ten days, the joint should rather be partially loaded. In order to maintain the functions of the joint and to support regeneration after the operation, physiotherapy is recommended, which begins on the first day after the operation.
Full exercise after around 10 days can help speed up hip regeneration. However, this should be done in constant consultation with the attending physician and physiotherapist.

Sports activities that can be carried out in a way that are gentle on the joints can be started a few weeks after the operation. Swimming, for example, is suitable here. After a few months, in most cases there is nothing in the way of full exercise and all kinds of sports.

Risks of hip arthroscopy

As with all operations, arthroscopy of the hip joint is not without its risks. Nevertheless, since the introduction of arthroscopy of the joint, the risks have been reduced enormously compared to the previously common operations on the hip joint.

Because the procedure is performed under general anesthesia, there are certain general risks that can occur with any procedure of this type.
These include the risk of stomach contents getting into the respiratory tract, damage to the teeth (during intubation), allergic reactions to the medication administered or disorders of the cardiovascular system. A complication that often arises due to intubation is a certain hoarseness after the operation, which usually improves quickly.

A possible and relatively common complication that can be attributed to the arthroscopic intervention itself is injuries to the structures of the joint or structures that run near the joint.
This includes nerve damage (in up to 5% of the treated people) which usually regresses on its own, bleeding when a blood vessel is injured, as well as damage to the cartilage structures within the joint.
There is also a risk of developing a thrombosis. For this reason, thrombosis prophylaxis is usually prescribed to prevent this complication that occurs after the operation.
Infections of the joint can also develop from the introduction of the instruments. However, since sterile equipment is used, it is a very rare complication.

Overall, however, performing an arthroscopy should be regarded as having few complications.

Reasons for an arthroscopy of the hip

There are a number of different diseases that can be effectively treated using arthroscopy of the hip.

One of the most common indications why hip arthroscopy is performed nowadays is what is known as femoro-acetabular impingement (FAI for short). This results in friction between the thighbone and the socket.
The cause of the occurrence of the impingement is a congenital defect of the acetabulum and / or the thigh bone, which leads to friction between the two bones. Arthroscopy can be performed to prevent the almost inevitable development of osteoarthritis due to the clinical picture.

Other causes why an arthroscopy is performed are the detection of free joint bodies in the joint, an injury to the ligaments of the joint, infections of the joint, hip arthrosis, cartilage damage (cartilage damage on the hip) and hip pain that cannot be assigned a cause.