Hip Arthroscopy

Original Editor - Chloe Waller

Top Contributors - Chloe Waller  

Description
[edit | edit source]

Hip pain

Hip arthroscopy refers to less invasive surgery to assess or treat hip pathologies[1]. Arthroscopy avoids dislocation and causes less trauma to the tissues, including avoiding the cutting of the ligamentum teres, leading to less complications and quicker recovery and return to activity[2]. This approach is increasing in popularity[3].

Indications[edit | edit source]

Femoroacetabular Impingement (FAI).[edit | edit source]

FAI is a common cause of hip pain in young people, and is caused by the of abnormal contact between acetabular rim and proximal femur during movement[4].

Arthroscopic surgeries have been found to have statistically similar outcomes when compared to traditional open surgeries[5]. A 2019 meta analysis and systematic review of 31 studies including a total of 1981 hips among 1911 patients for hip arthroscopy for FAI showed high percentage of patients return to sport activities (87.7%) and significant improvement in all patient-reported outcome measures, except for mental health, with a low rate of complications (1.7%) and re-operation (5.5%)[6]. A multi-center, assessor-blinded randomized controlled trial of 348 patients found hip arthroscopy and personalized physiotherapy both improved hip-related quality of life for patients with FAI. Hip arthroscopy led to a clinically significant greater improvement than personalized physiotherapy (p=0·0093)[7]. <gallery widths="250px" heights="350px">

Pincer morphology
Cam morphology
Labral Tears[edit | edit source]
Labral tear

Arthroscopy can be used to find and diagnose labral tears, as well as for repair, debridement, or segmental resection procedures[3].

Greater Trochanteric Pain Syndrome[edit | edit source]

For greater trochanteric pain syndrome, arthroscopic bursectomy, decompression or Iliotibial band release have had successful outcomes[4].

Snapping hip
Snapping Hip Syndrome[edit | edit source]

For external snapping hip syndrome the iliotibial band can be released, allowing the greater trochanter to move freely without snapping. For internal snapping hip syndrome, the Iliopsoas tendon snapping over can be released, to prevent snapping on the iliopectineal eminence or the femoral head[4].

Paediatrics[edit | edit source]
Trauma[edit | edit source]
Hip dislocation

Traumatic hip dislocation treated by reduction can go on to cause chondral damage, labral tears, loose bodies, ligamentum teres avulsion and peri-articular fractures. Therefore patients with ongoing symptoms can be diagnosed and treated via arthroscopy. [4]

Sepsis[edit | edit source]

There have been multiple small studies with successful outcomes treating septic hip via arthroscopic wash out and debridement[4].

Cartilage[edit | edit source]

A 2016 systematic review found patients with high grade chondral deficits had improved short and medium term improvements post arthroscopic debridement, microfracture, and autologous chondrocyte transplantation[8]. Successful arthroscopic cartilage repair has also been reported[4].

Inflammatory Arthropathies[edit | edit source]

A retrospective study of 40 hips in 36 inflammatory arthritis patients (17 ankylosing spondylitis, 11 rheumatoid arthritis, and 8 psoriatic arthritis) post arthroscopic irrigation and debridement found improvement in joint range of motion, synovitis on MRI and Harris, Oxford Hip and VAS scores (P<0.05)[9].

Osteoarthritis[edit | edit source]
Hip osteoarthritis

Evidence supports there is a correlation between FAI and early osteoarthritis (OA), and research hypothesizes hip arthroscopy for FAI can prevent the progression of arthritic changes to articular cartilage, however, at present there is insufficient high level evidence to confirm this.There is support that some early OA stages (Tonnis Grade 1 or less and if joint space is preserved by at least 2 mm) can see symptomatic improvement with arthroscopic management of Cam/Pincer deformities or reshaping of the femoral head.[3]

Complications[edit | edit source]

In two prospective studies with 640 and 1054 patients, the rate of complications was 1.6% and 1.4% respectively. Specific complications included:[4]

  • Haemorrhage
  • Bursitis
  • Mild peripheral nerve injury
  • Instrument breakage
  • Chondral or labral damage.

Physiotherapy Management[edit | edit source]

Post hip arthroscopy physiotherapy protocols vary in weight-bearing, range of motion, bracing, strengthening, and return to sport guidance's[10]. Evidence supports using a personalized, criteria-based progression through rehabilitation stages, such as Domb, Sgroi and Van Devenders' (2016) physiotherapy guidelines supported by 2-year outcomes, which are linked below for guidance[11]. Outcome measures should include biopsychosocial patient-reported outcomes[12].

General principles include[13]:

Resources[edit | edit source]

Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes

References[edit | edit source]

  1. NHS. What is an arthroscopy? Available from: https://www.nhs.uk/conditions/arthroscopy/ (Accessed 18/01/2023)
  2. Briggs KK, Bolia IK. Hip arthroscopy: an evidence-based approach. Lancet. 2018 Jun 2;391(10136):2189-2190.
  3. 3.0 3.1 3.2 3.3 3.4 Cross GWV, Sobti AS, Khan T. Hip arthroscopy in osteoarthritis: Is it an option? J Clin Orthop Trauma. 2021 Sep 30;22:101617
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Jamil M, Dandachli W, Noordin S, Witt J. Hip arthroscopy: Indications, outcomes and complications. Int J Surg. 2018 Jun;54(Pt B):341-344.
  5. 5.0 5.1 de Sa D, Lian J, Sheean AJ, Inman K, Drain N, Ayeni O, Mauro C. A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery. Orthop J Sports Med. 2018 Sep 21;6(9):2325967118796222.
  6. Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement. Am J Sports Med. 2019 Feb;47(2):488-500.
  7. Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, Petrou S, Realpe A, Smith J, Foster NE; FASHIoN Study Group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018 Jun 2;391(10136):2225-2235.
  8. Marquez-Lara A, Mannava S, Howse EA, Stone AV, Stubbs AJ. Arthroscopic Management of Hip Chondral Defects: A Systematic Review of the Literature. Arthroscopy. 2016 Jul;32(7):1435-43.
  9. Zhou M, Li ZL, Wang Y, Liu YJ, Zhang SM, Fu J, Wang ZG, Cai X, Wei M. Arthroscopic debridement and synovium resection for inflammatory hip arthritis. Chin Med Sci J. 2013 Mar;28(1):39-43
  10. Grzybowski JS, Malloy P, Stegemann C, Bush-Joseph C, Harris JD, Nho SJ. Rehabilitation Following Hip Arthroscopy - A Systematic Review. Front Surg. 2015 May 26;2:21.
  11. Domb BG, Sgroi TA, VanDevender JC. Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes. Sports Health. 2016 Jul;8(4):347-54.
  12. Giordano NA, Kent M, Buckenmaier CC 3rd, Mauntel TC, Dickens JF, Millington M, Highland KB. A Longitudinal Comparison of Patient-Reported Outcomes Measurement Information System to Legacy Scales in Knee and Shoulder Arthroscopy Patients. Arthroscopy. 2021 Jan;37(1):185-194.e2.
  13. Physioworks. Knee Arthroscopy. Available from: https://physioworks.com.au/physiotherapy-treatment/knee-arthroscopy/ (Accessed 19/01/2023)