This is a relatively recent advance in orthopaedic surgery. It is used to treat groin pain in young, active adults (20-40 years old).
The hip socket has a rim of tissue attached to its circumference called the labrum.We are all born with differently shaped hips. If a bony bump is present in your hip, it can impinge and damage the labrum (femoroacetabular impingement or FAI). This causes groin pain and discomfort with certain activities. The labrum is protective to the articular cartilage of the socket (acetabulum). If labral damage continues, then the articular cartilage of the socket becomes damaged. This can lead to osteoarthritis.
The purpose of hip arthroscopy is to prevent arthritis from starting by dealing with the damaged labrum and taking away the bump that causes the problem. The labrum can be repaired or trimmed to a stable rim.
Activities which make the pain worse
- sitting for long periods
- getting up from sitting
- getting in/out of cars
- climbing stairs
- sports like football, hurdling, rowing
The operation is performed under a general anaesthetic. It involves distracting the hip joint and with x-ray guidance, placing a camera and an instrument into the joint.
Labral damage can then be treated and the joint can be fully inspected.
The bump which has caused the damage can be removed through keyhole surgery although occasionally it is necessary to make a small incision at the front of the hip through which it can be removed.
Diagram of a hip arthroscopy Intra-operative x-ray of camera and instrument being placed
View from the camera inside the hip joint.
1. Damage to nerves and vessels
This can occur when placing the instruments as there are many nerves and vessels around the hip joint.
Infection of the wounds occurs in about 1% of cases
3. On going pain
When I distract the hip to insert the instruments, the strong ligaments around the hip are stretched. After the operation this can feel like a groin strain and could last up to 6 weeks.
4. Bruising / swelling of genitalia
Another problem occurring due to distraction of the hip. A padded bollard is placed between the legs which stops you from being pulled down the table when traction is applied. I take great care to minimise the traction time and to protect the groin area.