This surgery is extremely successful for resolving the symptoms of hip impingement.
Typically, a hip arthroscopy surgery is performed through several small poke holes over the hip. An arthroscopic camera and specialized small instruments are inserted through these small incisions. This allows for excellent visualization inside the tissues of the hip but minimal soft tissue disruption during the surgery. With these principles in mind, hip arthroscopy can be utilized to treat hip impingement, labral tears of the hip, cartilage injuries in the hip, abductor tendon tears, hip flexor tendon pathology, hip infections and more.
Most commonly, hip arthroscopy is used to treat hip impingement. Hip impingement, or femoroacetabular impingement (FAI), is a condition where the ball and socket of the hip joint do not fit together perfectly spherically in the front portion of the hip. This leads to the bones pinching together when the hip is brought into flexion, like in a deep squat or crouch. This can cause pain, and it can often lead to labral tearing or cartilage damage. FAI typically affects active people in their 20s, 30s and sometimes 40s. Athletes that are frequently required to have their hips in a flexed position, such as catchers, hockey goalies, gymnasts and cyclists, are often impacted by the symptoms of FAI; however, the condition is not limited to athletes.
For patients in the second through fourth decades of life suffering from FAI, arthroscopic surgery can be utilized to repair any tearing of the labrum and to reshape the bones so that the joint is perfectly spherical. This surgery is extremely successful for resolving the symptoms of hip impingement. Additionally, the exact effect of hip impingement on the development of arthritis is not entirely known; however, some data suggests that untreated hip impingement may be associated with an increased risk of arthritis over time. Because of this, treating symptomatic impingement with hip arthroscopy may actually prevent hip arthritis in the future.
Once a hip joint has developed arthritic changes, it is not appropriate for hip arthroscopy surgery. This is because hip arthroscopy has not been shown to dramatically improve symptoms for patients with arthritis; in fact, in some cases (for reasons that are not entirely known), performing a hip arthroscopy on a hip with arthritis can actually accelerate the arthritic degeneration of the hip. Frequently, arthritis is associated with labral tearing in the hip. However, unlike the labral tearing that occurs with hip impingement, it is not helpful to perform hip arthroscopy surgery for labral tears associated with arthritis.
Instead, a more effective treatment once the hip has reached this stage of degeneration is to perform a hip replacement. A hip replacement removes the torn labrum and arthritic cartilage from the hip, and it is an excellent treatment for patients with hip arthritis. In general, hip arthroscopy is most suited for patients under the age of 50, while hip replacement surgery is most suited for those over the age of 50. FBN
By Todd Ludwig, M.D.
Dr. Todd Ludwig is a fellowship-trained sports medicine surgeon at Flagstaff Bone & Joint located at 525 N. Switzer Canyon Drive. Dr. Ludwig offers nonoperative and operative sports medicine treatment options for the hip, knee and shoulder. For additional information or to schedule an appointment, visit www.flagstaffboneandjoint.com or call 928-773-2280.