Intraoperative fluoroscopic image during anarthroscopic resection of a cam lesion of the femur. The upper instrument is the arthroscope (viewing device), while the lower is the high-speed burr used for reshaping the bone.
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Indications
Hip arthroscopy was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint itself. The most common indication is for the treatment of FAI (femoral acetabular impingement) and its associated pathologies such as labral tears and cartilage abnormalities, among others (see Table 1).
Table 1. A selection of hip conditions that may be treated arthroscopically.
| Femoroacetabular impingement |
| Labral tears |
| Loose / foreign body removal |
| Hip washout (for infection) or biopsy |
| Chondral (cartilage) lesions |
| Osteochondritis dissecans |
| Ligamentum teres injuries (and reconstruction) |
| Iliopsoas tendinopathy (or 'snapping psoas') |
| Trochanteric pain syndrome |
| Snapping iliotibial band |
| Osteoarthritis (controversial) |
| Sciatic nerve compression (piriformis syndrome) |
| Ischiofemoral impingement |
| Direct assessment of hip replacement |
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Complications
Hip arthroscopy is generally a very safe technique. However, as with all surgical procedures, there are possible pitfalls and complications. These can be divided into general complications of an operation and those specific to hip arthroscopy itself.
Anaesthetic complications
Anaesthetic complications are fortunately rare, but include post-operative chest infection, urinary retention (inability to pass urine), gastrointestinal problems (constipation, nausea), heart complications (such as an abnormal rhythm), and even death.
Operative complications
Despite being uncommon, less than 1%, the risk of infection after hip arthroscopy always present. Development of blood clots (deep-vein thrombosis) is also a risk, probably created by the slowing of blood flow in the veins as a result of reduced mobility.
As with all arthroscopic procedures, because the hip arthroscopy is undertaken with fluid in the joint, there is a risk that some can escape into the surrounding tissues during surgery and cause local swelling. Occasionally, this causes skin blistering. However, swelling usually resolves after 24 hours without intervention. Very rarely some of this irrigation fluid can track upwards into the abdomen. Should this occur, the patient may complain of back pain immediately after surgery.
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Postoperative rehabilitation
Each surgeon will have their own preferred physiotherapy schedule. Many are on their individual websites. A variable period on crutches after hip arthroscopy is common although physiotherapy is seen by many to play a very significant part in post-operative recovery. The regime usually starts with encouragement for a free range of movement, stretches and isometric exercises leading to subsequent dynamic, plyometric and weights exercises. Impact activities are usually discouraged for a minimum of three months, and contact sports for four.
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Results
The results of hip arthroscopic techniques will depend on the indication for the operation and perhaps also on the experience of the surgeon. Published reports are certainly encouraging, and the number of research papers reporting the results of hip arthroscopic surgery is increasing rapidly. As an approximation, for FAI surgery undertaken arthroscopically, 80% of patients feel their hips are improved one year after the operation, 15% feel their symptoms are unaltered while 5% may be made worse. If the procedure is being performed for early arthritis (wear and tear), the results are not as clear-cut, and a larger proportion may not feel benefit.
