The future is now: Minimally invasive hip arthroscopy

Most people have heard of shoulder arthroscopy and knee arthroscopy, but recently, hip arthroscopy has become a popular way for sports medicine orthopedic surgeons to treat problems in the hip joint using minimally-invasive techniques.

Two or three small, one centimeter incisions are made on the side of the hip, which allow for instruments and a camera to be inserted and surgery to be performed without a large, painful, open incision. This allows for a shorter, more comfortable recovery and a faster return to sport and other life activities. Full recovery usually takes four to six months.

While some hip arthroscopy patients undergo surgery to remove loose bodies in the hip joint, the most common indication for a hip arthroscopy is what is known as a labral tear. The labrum is a cartilage structure that surrounds the bony socket.

I explain to my patients that, like the rim on a cafeteria tray, the labrum helps to increase the surface area of the acetabulum and acts like a suction seal to keep the ball in the socket. The most common reasons the labrum tears are trauma and a condition known as femoroacetabular impingement (FAI), in which there is extra bone that forms during development on either the ball or the socket of the hip joint. As a result, over time, that extra bone can rub on the labrum and cause it to tear.

Patients usually complain of sharp, pain deep within the groin, primarily with flexion and internal rotation. A special MRI known as an MRI arthrogram is obtained prior to surgery to understand exactly what structures need to be addressed.

If non-operative modalities such as physical therapy and activity modification fail to fully resolve symptoms – usually, groin pain with or without clicking and locking – surgery is recommended to repair the labrum and shave down the extra bone. FAI is now thought to be the most common reason for early-onset arthritis in the hip. However, if there is any evidence of arthritis on initial evaluation, hip arthroscopy is not recommended.

In addition to tears inside the hip joint, more recent advances have been made to repair tears on the outside of the hip, referred to as gluteus medius tears. Known as the “rotator cuff tear of the hip,” these are tears of the muscle that help to support the leg during stance phase and to swing the leg outwards. While often these tears are degenerative and not traumatic, the most common symptom is pain on the side of the hip that fails non-operative treatment options such as physical therapy and a steroid injection.

With a steep learning curve, arthroscopic hip surgery should be performed by a surgeon who has received additional specialized fellowship-training in hip arthroscopy, as there is very little room for error. While many of my patients return to full, unrestricted activities after arthroscopy, ultimately, full recovery depends on the degree of pre-operative damage present in the hip.

Dr. Zachary Domont is a board-certified orthopedic surgeon with Advocate Medical Group Orthopedics at Advocate Condell Medical Center who specializes in hip, knee and shoulder arthroscopy, cartilage restoration and adult and pediatric sports medicine. He sees patients in Lincolnshire, Libertyville and Crystal Lake, Ill. Dr. Domont is currently accepting new patients – to learn more about him or to schedule an appointment, click here.