Hip arthroscopy is a completely different technique to hip replacement; it is used to diagnose and treat a range of conditions that occur in younger patients. Older people with hip arthritis generally do not benefit from hip arthroscopy.
The procedure has only become possible since the early 1990s. As it has advanced, hip arthroscopy has provided new information about hip joint problems in young people, particularly young athletes. Today it is possible to have a hip arthroscopy within the NHS and several private hospitals in the UK also offer it. This surgical technique rarely involves an overnight stay in hospital and enables several different hip conditions to be diagnosed and treated successfully. Many of these would previously have gone unrecognised and put down to ‘general groin injuries’, causing long-term mobility problems and chronic pain in promising young athletes.
What does hip arthroscopy involve?
To say hip arthroscopy is a difficult technique would be something of an understatement. It is much more technically challenging than the more common knee arthroscopy and the learning curve for a surgeon new to hip arthroscopy is extremely steep. The gap between the ball and socket of the hip joint is very small; as recently as 1931, doctors thought that it was impossible to place a needle here. Today it has become possible to view the inside of the hip joint using a keyhole technique and a tiny endoscopy camera. Tiny surgical instruments can also be introduced to carry out treatments.
The operation is specialised and is usually done under general anaesthetic as the position of the hip joint is crucial to a successful procedure. A very fine and long needle is first used to get into the joint, avoiding the main nerves. Then around 40ml of sterile saline is pumped in to open up the joint to provide access for the other instruments. Recovery time is fast; this is a minimally invasive technique that does not disturb the major muscles, tendons and ligaments that support the hip joint.
Using hip arthroscopy for diagnosis
Hip arthroscopy can be useful in younger people and active athletes who experience symptoms such as groin pain, a feeling of ‘clicking’ inside the hip joint, unexplained hip joint stiffness, poor performance due to hip problems, having one of the legs just ‘give way’ for no reason. Before hip arthroscopy was developed, X-rays were routinely used but early changes in the hip joint do not show up well. Even advanced MRI imaging using a radioactive tracer such as gadolinium cannot detect problems such as internal cartilage tears or loose material within the joint. All of these are clearly visible in the images produced by a hip arthroscopy, which examines every surface of the inside of the hip joint.
Hip arthroscopy treatments
Hip arthroscopy can be used to treat several conditions that can result from sports injuries, avoiding the need for more extensive hip surgery:
Acetabular labral tears – ruptures in the ring of cartilage that surrounds the socket of the hip joint can be seen easily during a hip arthroscopy and most can be repaired during the procedure.
Chondral injuries – damage to the smooth cartilage that lines the hip joint, either on the socket side or on the ball side, can be repaired during hip arthroscopy.
Loose bodies – these are identified and removed.
Snapping hip syndrome – can occur when the tendon at the front of the hip joint snaps over the bone. This can be treated during hip arthroscopy by loosening the tendon or by treating an underlying tear in the cartilage that is responsible for tendon tightening.