Hip Pain, Do I Need a Scope?

If you suffer with hip pain, there are several conservative treatment options as well as surgical intervention to manage your symptoms.  In the past, if you pursued surgery it was performed “open” which required a long incision to allow access to the joint; over the past 20 years orthopedic surgeons have had another option to treat some chronic and acute hip conditions-hip arthroscopy.

Along the same lines as a shoulder or knee arthroscopy, a hip arthroscopy (scope) uses small incisions to allow access for a camera and small instruments into the hip joint to provide surgical management for several conditions.

 

You may find yourself asking, is this the right surgery for me?

Hip arthroscopy can be used for a number of hip issues including:

 

Hip anatomy

Your hip joint is composed of your femur and your pelvis, it is a “ball and socket joint”.  The femoral head (ball) fits into the pelvis at a structure called the acetabulum (socket).  There is also a gasket-like structure around the acetabulum called the labrum.  The labrum helps provide stability to the hip as well as feedback for hip position.

 

How do you know if hip arthroscopy is the right treatment for you?

You will need to have an evaluation with an orthopedic surgeon.  They will do a thorough exam of your hip to check flexibility, strength, range of motion and evaluate movements that cause pain.  You will also have x-rays of the hip taken to check your joint spaces and look for other bone or joint issues.  Depending on the outcome of your exam you may be scheduled to undergo an MRI to look at the ligaments, cartilage, and structures like the labrum.  Structures of the hip may also be visualized using ultrasound.

After your physician has examined you and reviewed your imaging studies, they will develop a plan of care.  Depending on your diagnosis, there are non-surgical options available before heading straight to the OR.  Your doctor may offer the option of physical therapy, oral anti-inflammatory medications, or a steroid injection into the joint.  You will be given you the pros and cons of these options to determine how aggressive you want to be in your treatment. 

Depending on your hip condition, for example a tear of your labrum, you may be offered surgical intervention as a first line of treatment. 

You could also have a diagnosis that excludes you as a candidate for a hip scope.  A diagnosis of hip arthritis is not treated with a hip arthroscopy.  In this instance, your physician will likely discuss conservative management of your symptoms with injections, oral medications or ultimately a total joint replacement. 

What happens during surgery

You will be taken into the OR and positioned lying on your back.  Traction is applied to your leg to slightly open your hip joint; this allows access for your surgeon’s instruments.  An x-ray unit called a C-arm will be used to capture real time images of your hip; this helps your surgeon know where to insert the surgical instruments.  You will have 2-3 small incisions about the size of a buttonhole.  Your surgeon will use their camera to evaluate the hip joint.  During surgery they can smooth torn cartilage, remove loose bodies, trim bone spurs that can cause impingement, and repair labral tears.   This is an outpatient procedure, and you will go home the same day. 

If you had a repair, you will need to use crutches for about 4-6 weeks following surgery and limit your activities.  Occasionally your surgeon will have you wear a brace.  You will also attend physical therapy following surgery to work on your motion and strengthening the hip. 

Hip arthroscopy is a great minimally invasive procedure that can provide pain relief and management of several hip conditions.  

 

 

 

 

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