Hip arthroscopy
Professor Mark Rickman
Hip arthroscopy Adelaide
Patient journey
When is hip arthroscopy recommended and how patients are assessed
In almost all cases, non-surgical treatment is tried first. This may include physiotherapy, exercises, pain killers, and sometimes injections. There is little evidence to guide how long non-operative treatment should be tried, but it is reasonable to attempt at least 3 months before considering surgery. To some extent this depends on how symptoms are responding – if there is no improvement at all after 6-8 weeks then a surgical opinion is reasonable; if there is at least some improvement after 12 weeks then it is reasonable to try non-operative treatment for longer. Each case is different, and patients have different priorities and timescales.
Surgical appointment
First appointment
Prior to your first appointment you will receive an email with a link to fill in a form. This gives us a record of many aspects of your symptoms, how they came about, how much they bother you, when they affect you most, .
At your appointment, a full history and examination are undertaken, using the pre-filled in form as a starting point.
This will include an assessment of your Body Mass Index – BMI. You can find out more about this and check yours here. BMI Link. Hip arthroscopy involves working through very small incisions, on a joint that is several centimetres from the skin; the greater your BMI, the harder the surgery is. In patients with a BMI over 35, it can be impossible to perform hip arthroscopy safely.
We will also check for Hyper-mobility. One of the major factors that can lead to hip symptoms is if the joint has an unusual amount of mobility, usually too much but occasionally stiffness. Hypermobility is assessed most commonly with a score called a Beighton score, which is a number from 0 to 8. Anything over 3 is abnormal.
Imaging
X rays
In almost all cases a simple x ray tells us a lot about the hip joint - in terms of structure and shape, as well as the presence of any degenerative changes. If these have not been done, then they may be requested at the first appointment.
MRI
An MRI scan is usually carried out around the time of first appointment. This scan allows us to see the cartilage in the hip, diagnose labral tears, and assess the surrounding soft tissues. It is also important as a tool to rule out other potential causes of pain, such as muscle injuries, pelvic problems or tendon injuries.
CT
Not all cases need a CT scan, but many do. The CT scan is much better than MRI at looking for abnormalities in the shape of the bone on both sides of the hip joint. It also allows a 3D reconstruction to be done, which can be more helpful than simple 2D imaging. In addition, for many cases we use software that goes beyond a 3D reconstruction, and allows an interactive reconstruction. This can tell us much more about the presence of any bony impingement, and if present allows a pre-operative plan to be made regarding how much bone requires re-shaping, and where exactly bone should be removed from. This is one of the hardest things to judge intra-operatively, and pre-operative imaging such as this can be remarkably helpful.
