Hip arthroscopy
Professor Mark Rickman
Hip arthroscopy Adelaide
What does it entail ?
A hip arthroscopy is a surgical procedure where a small camera called an arthroscope is inserted into the hip joint, allowing the surgeon to see the inside of the hip joint without making large incisions. The camera is inserted through a very small cut (less than 1cm) – down a tunnel called a portal, and high definition images are transmitted to a large screen in front of the operating surgeon. Typically 2 portals are created, sometimes 3, and through the secondary ones long thin tools can be inserted allowing the surgeon to address various problems within the joint, all seen on the video screen. By avoiding large incisions and damage to surrounding muscles, patients have less pain after surgery and a more rapid recovery, compared to typical open surgery done without the arthroscope.
Anaesthetic
Most of the time this operation is done under a general anaesthetic, although occasionally a spinal anaesthetic is used instead.
Preparation
The patient is supine (lying on their back), on a specialised operating table. The operating table allows traction to be applied to the hip joint, distracting it by a few millimetres – this creates enough space to insert the camera and surgical tools.
Procedure
Using live x-ray as a guide, a long thin needle is first inserted into the hip joint. Once this is confirmed to be in the right place, an even thinner blunt-ended long guide wire is passed down the needle and the needle withdrawn.
Blunt trochars are passed over the guide wire to create a portal which is 4.5mm to 5.5mm in diameter. The camera and a fluid delivery system are passed down the first portal, allowing visualisation of the inside of the hip joint magnified on a large screen. The fluid flows throughout the operation – this helps to keep the view clear, and also helps control any bleeding.
A second portal is the established in a similar way, but instead of using x-ray the needle position in the joint can be seen on the screen, as the camera is now in place. The surgeon is then in a position to assess the entirety of the hip joint, and address any pathology that can be identified.
High quality photos and sometimes video can be recorded by the camera, and these are usually given to the patient as part of their operative record after surgery.
Once the inside of the hip has been addressed, the camera and tools can be moved slightly more peripherally, and the area just next to the femoral head can be seen and assessed. The traction on the hip joint is usually released at this stage. This area is called the head-neck junction; it is still within the capsule of the hip joint, but not between the ball and socket. A build up of bone in this area can impinge on the labrum / acetabulum causing damage with repeated movements. This excess bone can be removed / re-shaped using a small (4-5mm diameter) high speed burr.
At the end of the procedure, the joint is washed out, and the capsular incisions are closed as necessary. Local anaesthetic is administered into the joint and surrounding area, and dissolvable sutures are put in the skin incisions.
Immediate post surgery
The surgery itself typically lasts 45 to 90 minutes, depending on what is discovered and what surgery is performed. After surgery the majority of patients stay in hospital overnight (although it is possible to do this as a day case procedure as well). All patients have a post-operative consultation with one of the specialist physiotherapy team prior to discharge, and a plan is made for ongoing physiotherapy . The physiotherapists will assess patient mobility prior to discharge, and whether crutches are necessary. It is common to use crutches for a few days after surgery, but rarely for much longer.
Prior to discharge a follow-up consultation in the outpatient clinic is also scheduled, typically around 2 weeks later.
