Hip Arthroscopy and Hip Joint Preservation Surgery
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Hip impingement syndrome , in which the bones of the hip are abnormally shaped, may also lead to friction in the joint. This unusual friction may result in pain and discomfort, an eventual loss of cartilage all over the hip joint, and the development of osteoarthritis. As recently as five years ago, there were few options available to prevent the onset of osteoarthritis of the hip. Today, NYU Langone doctors often recommend surgery if they diagnose a prearthritic condition based on the results of MRI scans or diagnostic imaging tests.
Procedures can be performed to delay or prevent the progression of hip arthritis. Our doctors have the experience to diagnose a prearthritic condition before it advances to osteoarthritis.
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Hip arthroscopy is a procedure that allows a surgeon to access the hip joint using small incisions, avoiding contact with nearby muscle and other soft tissues. Your doctor may recommend arthroscopy to repair a torn labrum, remove bone spurs that develop on the femoral head, and remove any loose pieces of cartilage or other tissue in the joint. To perform arthroscopy in the hip, doctors use general or regional anesthesia.
A surgeon makes an incision in the hip and inserts a pencil-sized instrument called an arthroscope into the joint. The arthroscope has a light and a camera lens on its tip and broadcasts magnified images of the inside of the hip joint on a monitor so the doctor can see it clearly. The surgeon uses the arthroscope to locate the area in the hip joint that needs attention and inserts surgical instruments through a second small incision to retrieve loose pieces of cartilage or other tissue, remove bone spurs, or repair the labrum.
After the procedure, the surgeon closes the incisions with stitches. You can expect to return home the same day as the surgery. Some people experience relief from painful symptoms almost immediately after the procedure.
Access the fully searchable text online at www. Arthroscopic surgery of the hip: current concepts and recent advances. Fewer lymph node operations for breast cancer patients with new prediction models Sep 20, The arthroscopic camera enables the surgeon to see the interior of the hip, fluid is injected into the joint space to enlarge the space for the surgical procedure. Your feedback will go directly to Science X editors. Predictive factors for THA were also analyzed. Centre for Arthroplasty.
If cartilage has begun to wear away, microfracture surgery may help stimulate the growth of new cartilage by increasing the blood supply to the surface of the joint bone. Doctors use general or regional anesthesia and perform this minimally invasive surgery using an arthroscope. After the scope is in place, surgeons insert a tool through a second incision to make tiny holes, or microfractures, in the bone beneath the cartilage layer.
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These microfractures allow more blood to flow to the cartilage layer, which stimulates the growth of new cartilage. After surgery, your doctor provides crutches so you can move around without putting any weight on the affected hip for six weeks. This allows new cartilage to form. During this time, a physical therapist helps you maintain flexibility with stretching exercises and movements designed to restore range of motion in the hip. After six weeks, your physical therapist adds weight-bearing exercise to your routine in order to build strength in your leg and back muscles.
Doctors recommend at least 12 weeks of physical therapy and assess your progress every four weeks. Periacetabular osteotomy, also known as Ganz osteotomy, is a procedure to reposition the hip socket, or acetabulum, in order to provide a better connection for the ball-shaped top of the thigh bone, called the femoral head.
Hip Arthroscopy and Hip Joint Preservation Surgery
This suggests that care should be exercised while designing protocols for obtaining radiographs in each department to ensure rotation of the hip is kept as constant as possible. Until recently arthroscopy had been reserved for the younger adult. The main goal has been to provide pain relief, maintain a premorbid level of activity and curb the progression of arthritis in the longer term.
In some studies, the outcome measure in the older age group over the age of 50 has been conversion to total hip replacement. Studies have shown that acetabular labral tears, which we now know are a direct result of the cam-type deformity, are the most common pathology in patients undergoing hip arthroscopy [ 25 , 26 ], and the likely cause of mechanical symptoms.
Therefore, if a patient over the age of 50 years with little or no evidence of arthritis on their plain film radiographs, presents with mechanical features suggestive of a labral tear, one might presume it should be reasonable to offer them a hip arthroscopy.
Hip pathology and nonarthritic hip conditions have only recently been recognized as a cause of hip pain. In , Ganz, Leunig and colleagues described the. Hip arthroscopy for joint preservation surgery has grown immensely over the last two decades. There is now an increasing trend to try and.
In an age-matched study using under year olds as a control, progression to THR was seen in Another study showed that in patients over the age of 50, even with no pre-operative radiological signs of arthritis, hip arthroscopy did not significantly improve their range of movement [ 28 ]. This shows that a sizeable proportion of the over 50 population with no radiological signs may indeed have arthroscopic signs of early arthritis, which brings into question whether or not a surgeon can realistically separate the older patient from the older patient with early signs of arthritis.
And if they can, is this purely academic? A single-surgeon cohort of patients who had arthroscopy for labral pathology, was followed up for a minimum of 2 years to assess the influence of age and arthritis on outcomes [ 29 ]. The finding was that the presence of Outerbridge [ 30 ] Grade IV changes at arthroscopy were predictive of a worse outcome compared with the non-arthritic cohorts. This looked at age only, not patients with signs of arthritis, and still found poor outcomes.
Age therefore plays a significant factor in the decision of whether or not to offer a patient hip arthroscopy. A recent systematic review undertaken by Domb et al. The outcome measure used was the need for a joint replacement. They recognized the differences in measurement and grading of arthritis between the studies as a potential limitation, however found seven factors that negatively correlated with post-arthroscopy outcomes. In the non-arthritic cohort, 8.
In another study, the mean time of progression to THR was between 7 months and 4. This systematic review used 22 studies and looked at progression to arthroplasty as an outcome. They also show that femoral chondral disease as seen at the time of arthroscopy was associated with a 58 times greater risk of progression to THR than those without; compared with a 20 times greater risk in those with acetabular chondral damage.
They found that the limiting factor in treatment outcome was the amount of cartilage damage that had occurred prior to surgery. Safran and Epstein, in a small case series, showed that there may be a role of arthroscopy in protrusio acetabuli, but admitted that it could only partially tackle the problem [ 34 ]. However, McCarthy and Lee strongly suggested that protrusio was a contra-indication to hip arthroscopy as there was limited potential for joint distraction [ 35 ]. This clearly shows that hip arthroscopy, which in itself has a significant recovery and rehabilitation period, is not the treatment option of choice when arthritis is evident.
The question of how much arthritis is too much is a complex one to fully answer, but many factors must be taken into consideration. Firstly, those studies using Outerbridge scores have not correlated their findings with pre-operative radiographic signs. This measurement should be taken alongside the overall deformity profile however, as was discussed earlier, the pincer-type deformity without cam presence may in fact be protective of OA, with narrow joint space not progressing beyond a certain threshold [ 18 , 39 ]. The goal in young adult hip preservation surgery is to provide pain relief, maintain the level of premorbid activity and prevent progression to OA requiring a joint replacement.
The goals are surely different in the middle-aged adult with signs of early arthritis.
Although Lubowitz et al. It stands to reason that if a patient is in their 50s and leads a moderately active lifestyle, hip arthroscopy may provide the relief they require to continue those activities for a few years longer [ 35 ], but they must understand the significant risk of their decision. All the recent work into outcomes of hip arthroscopy has shown us when to use caution. Patients with signs on AP radiographs of morphological abnormalities, particularly the presence of posterior wall sign and reduced medial proximal femoral angle, also have increased odds of arthritic progression [ 19 ].
These factors serve to help with deciding surgical treatment options and curb patient expectations. There are studies that support the use of arthroscopy even in the face of OA, but even some of these show a high reoperation rate and progression to THR [ 25 , 27 , 33 , 36 ]. The basis of decision-making should be formed upon a discussion with the patient regarding their expectation of hip arthroscopy and their understanding of the lengthy rehabilitation process that may ensue following arthroscopic intervention.
Discussion must also emphasize the possible finding of arthritis at the time of procedure even if there are minimal radiographic signs pre-operatively. The goals of treatment do change in the over 40s and in those with recognizable OA. With many studies showing a high conversion rate within a short period following arthroscopy, perhaps in the face of moderate arthritis, arthroscopy cannot delay the need for hip arthroplasty.
National Center for Biotechnology Information , U. J Hip Preserv Surg. Published online Feb Viswanath and V. Author information Article notes Copyright and License information Disclaimer. Corresponding author. E-mail: ku. Received Nov 10; Accepted Nov Published by Oxford University Press. For commercial re-use, please contact journals. This article has been cited by other articles in PMC. Abstract Hip arthroscopy for joint preservation surgery has grown immensely over the last two decades.
Femoroacetabular impingement: a cause for osteoarthritis of the hip.
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Clin Orthop Relat Res ; — Alshameeri Z, Khanduja V. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint. International Orthopaedics ; 38 8 — Imam S, Khanduja V. Current concepts in the diagnosis and management of femoroacetabular impingement. International Orthopaedics ; 35 10 — Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol ; 38 — Harris WH. Etiology of osteoarthritis of the hip.
Clin Orthop Relat Res ; 20— Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement. Am J Sports Med ; 38 —5. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers.
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