J. W. Thomas Byrd, M.D.
Arthroscopy: Vol 22, No 12 (December), 2006: 1260-1262
Arthroscopy can be performed in almost every synovial joint of the body with proven success. The hip joint is deeply located, has a thick and closely applied capsule and is surrounded by a large bulk of soft tissues. These factors pose a challenge for any surgeon to perform arthroscopy of the hip joint. Often traction is required and proper positioning is essential.
Hip arthroscopy is most commonly performed for labral lesions. Debridement of painful labral tears result in favourable outcome. Repair of degenerative lesions may not be productive. The clearest indication for hip arthroscopy is symptomatic loose bodies and arthroscopy is much less invasive compared to traditional open techniques. Femoral acetabular impingement can often be successfully managed with arthroscopy.
Acute articular injury sometimes results from direct blow over the greater trochanter, especially during contact sports. Excision of the unstable fragments can be successfully performed arthroscopically. Patients respond remarkably well to arthroscopic intervention to traumatic rupture of ligamentum teres.
Intra-articular pathologies associated with hip dysplasia can be dealt with arthroscopy. Hip instability is associated with hyperlaxity states such as Ehlers-Danlos syndrome and arthroscopic capsulorrhaphy is helpful where joint geometry is normal. Subtotal arthroscopic synovectomy can be performed for indications as in any other synovial joint. Simple debridement for arthritis of hip is only occasionally rewarding. Adhesive capsulitis of the hip is similar to that in the shoulder and arthroscopy has produced successful results. Arthroscopy for end stage avascular necrosis has produced poor results.
In sepsis, arthroscopic washout has been reported to have good results even in the presence of total hip arthroplasty. Further research in required to redefine the indications for arthroscopic versus open treatment for septic arthritis of hip. The indications for hip arthroscopy are many and growing. A successful outcome is clearly dependent on patient selection. The indications will evolve according to individual surgeon’s experience.
