Hip Arthroscopy : Indications, Procedure, Cost, & More

If you or someone you know is suffering due to a long-term problem with the hip, chances are that you may have heard of hip arthroscopy. A healthcare provider may suggest hip arthroscopy for persistent hip pain that has not responded to any other form of treatment.

What is hip arthroscopy and why is it popular? Is it effective? Is it safe? How much does it cost? Get answers to all your questions about hip arthroscopy in this article. 

Hip arthroscopy is a minimally invasive and outpatient surgical procedure for diagnosing and treating hip joint conditions using a device called an arthroscope. The procedure may also be referred to as “hip arthroscopy surgery” or “hip arthroscopic surgery”. Some people may refer to it simply as a “hip operation”.

An arthroscope is a flexible tube-like device with a light source and camera at one end that is connected to a video monitor. It is inserted into the hip joint through small incisions close to the hip. The images it produces allow the doctor to view injuries, damage, or abnormalities in the hip on the video monitor.

After identifying the problem, special surgical tools can be inserted through other incisions to treat the problem as well. Treatment steps include removing extra pieces of loose bone in the hip joint or fixing damaged cartilage near the joint.

Although hip arthroscopy surgery is minimally invasive and thus not very stressful on the body, you will need physical therapy after the procedure to increase your strength and the ability to move your hip again.

Hip arthroscopy may be recommended for persistent hip problems that have been diagnosed accurately but have responded negatively to other treatment modalities such as medication, steroid injections, or physical therapy. These hip problems could include persistent pain and difficulties with moving the hip. 

Generally, hip arthroscopic surgery is recommended for younger patients with hip pain who do not require a partial or total hip replacement. In these cases, the cause of hip pain could be related to hip injuries associated with sports or overuse, or abnormalities in the shape of the bones that make up the hip joint. Hip arthroscopy could be used to repair soft tissue damage in the hip or to correct the shape and fit of the hip bones. 

The hip joint is a “ball and socket” joint made up of 2 bones. The ball is the head of the femur (part of the thigh bone) and the socket is the acetabulum (part of the pelvis). The hip joint is lined with a tissue called articular cartilage, which provides a smooth gliding surface for the joint to move freely. Around the rim of the acetabulum is a special type of cartilage called the labrum. 

Some conditions that hip arthroscopy is used to treat include:

• Hip impingement: Also known as femoroacetabular impingement, this is a condition where there is pinching between the bones of the hip joint due to irregular bone shape. Hip arthroscopy can be used to reshape the bones.
• Hip labral tear: A labral tear is an injury to the labrum. Hip arthroscopy can be used to clean out the damaged labrum, repair the tear, and help with the underlying hip impingement.
• Hip injury: If there are loose fragments of cartilage in the joint after an injury, hip arthroscopy can help remove the debris from the hip joint.
• Bone spurs: Also known as osteophytes, bone spurs are bumps that form on the ends of the bones and prevent the joint from gliding. These spurs can be shaved off with hip arthroscopy and the shape of the joint can be restored. 
• Synovitis: It is inflammation of the lining of the joint. Hip arthroscopy can be used to remove the inflamed tissue. It can also help diagnose and treat the underlying causes of inflammation.
• Hip dysplasia: It is a condition in which the thigh bone or femur does not fit appropriately with the pelvis. Hip arthroscopy can repair or reconstruct torn labrum, reshape the bones around the hip joint to improve the fit between the femoral head and socket, or tighten the joint capsule. All these changes can help treat hip dysplasia. 
• Tendon tears: Tendon, the tissue that attaches muscles to bones, can get torn away from the bones in the hip due to an injury. These torn tendons can be reattached using hip arthroscopy. 
• Tendon contractures: A contracture is a condition in which a tendon or tendon sheath stiffens and becomes permanently tight, thus restricting flexibility and joint movement. Hip arthroscopy can help release these contractures. 

• Before deciding on hip arthroscopic surgery, you should meet the doctor to discuss the procedure, its benefits, and risks. Use this consultation to discuss your expectations and any doubts you may have. 
• The doctor will ask for your complete medical and surgical history, as well as information on any medications and supplements you are taking. You may be asked to alter the dose of or discontinue certain medications that increase the risk of bleeding during the surgery.
• As part of pre-surgical testing, the doctor may recommend a complete physical examination and imaging tests such as X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI).
• If you smoke, it is advisable to stop at the earliest before the surgery. Further, you should limit your alcohol intake as much as possible before the surgery. 
• You should arrange for someone to drive you home after the procedure. 
• You may be asked not to eat or drink anything except water up to 12 hours before surgery.

• Hip arthroscopic surgery can be performed under general anesthesia (you are asleep) or regional anesthesia (you are awake but the body is numbed from the waist down).
• Before the procedure, the surgeon attaches your leg to a special positioning device to keep your leg and hip at the proper angle for the procedure. 
• Next, the surgeon marks points on the skin of the hip where the incisions are to be made.
• The surgeon starts by making one or more small incisions (1 to 2 cm long) for the insertion of the arthroscope and other surgical tools.
• Before inserting the arthroscope, the surgeon guides a needle to the hip joint and injects a fluid that creates pressure to keep the joint open and accessible.
• The surgeon inserts a guide wire and a tube using the pathway created by the needle. The arthroscope is then inserted through the tube. These steps minimize damage to the healthy tissues.
• The surgeon analyzes images of the hip joint and surrounding tissues on the monitor as the arthroscope makes its way inside the hip.
• After the problem is identified, the surgeon inserts different arthroscopic tools through the other incisions to treat the problem.
• To end the hip arthroscopy surgery, the incisions are closed using non-dissolvable sutures or surgical tape strips.

• After the surgery, you will be moved to a recovery room and monitored until you are completely awake. 
• Hip arthroscopy is usually an outpatient procedure, and you may be cleared to go home on the day of the procedure. 
• Once you are cleared for discharge, the doctor will give you a pair of crutches to avoid putting too much pressure on the operated hip. You will need to use the crutches for 1 to 2 weeks. 
• The doctor may also ask you to wear a brace on the hip for 3 weeks after surgery. 
• Expect some level of hip pain on the side of the surgery for a while after the procedure. It should reduce significantly or resolve in 3 to 6 months. Your doctor may prescribe pain medications to help during recovery. 
• You may feel or hear fluid moving in your joint after the procedure. The fluid will be absorbed by your body and its presence is normal. 
• Your doctor may refer you to a physical therapist to help you regain strength and mobility after the procedure. The physical therapist will provide instructions on hip stretches and exercises that you can do at home. You may need to continue the exercises for 6 weeks to a few months after the surgery. 
• Keep up with all your follow-up appointments with the doctor to help with recovery and progress. 
• You should be able to go back to study or work in about 6 weeks. Complete recovery may take 6 months to a year. 
• During recovery, remember to:
  • Avoid putting weight or pressure on the hip.
  • Keep the area elevated and apply ice.
  • Take showers but avoid soaking baths until the incision heals.
  • Keep the incision clean and covered.
  • Avoid high-impact exercise and sporting activities for at least 12 weeks.

Hip arthroscopy surgery is a minimally invasive procedure associated with several advantages, including:

• Faster recovery
• Lesser post-procedure pain
• Minimal blood loss 
• Reduced scarring
• Lower risk of complications

Potential complications or risks associated with hip arthroscopic surgery include:

• Anesthesia-related allergies
• Infection
• Bleeding
• Blood clots
• Damage to surrounding tissue or nerves
• Excessive swelling
• Numbness or tingling in the groin, thigh, or foot
• Requirement of further surgery

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