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Hip Arthroscopy May Delay or Eliminate Need for Hip Joint Replacement

“Hip arthroscopy is an innovative outpatient procedure that may delay or eliminate the need for hip joint replacement surgery in many patients,” according to John H. Yocum, M.D., a board-certified orthopedic surgeon associated with OrthoArkansas.

“During this minimally invasive procedure, a highly trained orthopedic surgeon makes small incisions and inserts a miniature camera and specialized instruments into the hip joint space,” he explained. “The camera projects a high-definition image onto a monitor in the operating room. The surgeon can see precisely where the problem area is located, and in some cases, remove or repair damaged tissue and prevent additional deterioration of the joint.”

Patients experience less pain and recover much sooner as compared to traditional open surgery, he noted. Conditions that may be treated with hip arthroscopy include arthritis, loose bodies, labral tears, synovitis, and femoro-acetabular impingement (FAI).

Arthritis of the hip causes the gradual loss of cartilage, which is a substance that acts as a cushion between bones, Dr. Yocum explained. The loss triggers a painful cycle of irritation and fraying of the joint. Until recently, hip joint replacement surgery was almost inevitable.

Loose bodies are fragments of cartilage that float in the fluid surrounding the joint. Healthy cartilage has a smooth surface, but as arthritis progresses, cracks may develop in the cartilage. When the cracks break off, they become “loose bodies” that can cause catching of the hip, pain, and damage to the joint, the long-time orthopedic surgeon said.

A torn labrum causes the hip to pop or to lock, and it also may scratch the bone’s surface. The labrum is a rim of cartilage on the socket side of the joint. A physician may perform hip arthroscopy to trim or repair a tear in this area before it causes significant damage.

Synovitis is inflammation of tissue lining the hip joint. It can be extremely painful. An orthopedic surgeon may remove portions of this tissue to give some patients pain relief, but complete removal cannot be performed through arthroscopy, Dr. Yocum noted.

Femoro-acetubular impingement causes abnormal pressure points between the ball (femoral head) and socket (acetabulum) due to abnormally shaped femoral head and/or acetabulum.  This leads to degenerative changes in the hip joint that may require total hip replacement.  Through arthroscopic remodeling of the abnormally shaped femoral head and acetabulum, the altered mechanics can be corrected thus preventing progression to degenerative arthritis and hip replacement

“Patients can typically get back on their feet more quickly after an arthroscopic procedure than an open surgery,” he added. “They may put weight on the hip immediately, but should use crutches for comfort. In many cases, they feel significantly better within one to two weeks.”

Exercise is essential during the first few weeks after the procedure. Patients should begin with gentle exercise and work on regaining strength and range of motion. Light activities such as biking and swimming often may be resumed within a few weeks.

“Each patient’s recovery varies, depending on a number of factors, and patients should check with their orthopedic surgeon about specific details related to their recovery,” Dr. Yocum said.