What is a hip arthroscopy?
Arthroscopy refers to a procedure done within a joint through small incisions, using an arthroscope (camera) to visualize the structures within. Arthroscopic procedures are commonly done on an outpatient basis.
Hip arthroscopic surgeries are performed to mainly address pathology within the joint, however, there are some procedures outside of the joint (i.e. gluteus medius tear, trochanteric bursitis, internal/external snapping hip) that we are able to address arthroscopically as well. We have detailed some of the more common hip arthroscopic procedures performed in a later section.
The set up for the hip arthroscopy differs greatly from other orthopaedic procedures, due to the anatomy of the hip joint. The patients are placed supine (on the back). Being that the hip is such a confined joint, traction must be applied under the guidance of fluoroscopy to allow for the placement of instruments. The amount force needed to distract the hip varies from patient to patient. We try to minimize the amount of traction to under 90 minutes. Minimizing the length of traction time will decrease the amount of neuropraxias that develop post operatively.
Incisions are made on the lateral aspect of the hip. The number of incisions varies from patient to patient depending upon their pathology. Each incision is approx 2cm long and is closed with either two or three sutures. These sutures are not dissolvable.
As Dr. Kelly enters the joint, he will address labral pathology by either repairing or debriding the labrum. The decision to repair or remove is based on the quality of the tissue upon viewing it with the camera.
There are two options for anesthesia: General or Regional. We prefer the use of a spinal (regional), as it allows for pain control immediately post op, and tends to minimize anesthetic side effects including, but not limited to, nausea, vomiting, pain at the site of insertion, spinal headache, etc. Some patients that have spine pathology, or bleeding disorders may not be candidates for the regional block. In this case, general anesthesia will be used.
Spinal vs. Epidural:
In the majority of cases, a spinal block is sufficient as opposed to an epidural. The two blocks differ in the location of the medication into the spine and an epidural is convenient for long cases, where the anesthesiologist can continually dose, according to the time. A spinal block is typically adequate for our procedure as surgical time is rarely over three hours. The anesthesiologist will speak with each patient prior to the procedure to go over the pros and cons. Ultimately, the decision is made by the patient.
One of the most frequently asked questions is, "Will I be awake for the procedure if I use a spinal?" This decision is also made by the patient. Prior to the block, the patient is sedated so they feel very sleepy and unaware of the injection. In most cases, the patient prefers to sleep during the procedure, so after the regional block is completed, additional sedation will be given so the patient can sleep during the surgery. This should also be discussed with the anesthesiologist the day of surgery.
Common Hip Arthoscopy procedures
A synovectomy is performed using radio frequency probes that are able to, with a controlled amount of heat, rid the capsule of inflamed tissue.
Treatment of Labral Tears:
The decision to remove labral tissue is based upon the location, chronicity, and vascularity of the injured fibrocartilage. Attempts are made to preserve as much healthy labral tissue as possible.
a. Labral Debridement : If the quality of the labral tissue is poor (crushed, erythematous, ossified) we perform a debridement of the labrum. This is done by using a rotating shaver in the joint that is able to "shave" the beat up labrum and with the use of a suction, remove the fragments from the joint.
b. Labral Refixation : If the quality of the labral tissue is adequate, an anchor is placed into the bone (acetabular rim). The suture attached to the anchor is then fed around the labral tissue and tied down to the acetabulum. We d