A minimally invasive procedure used to diagnose and treat a wide range of hip conditions including impingement, labral tears, loose bodies and cartilage lesions. Fellowship trained with a focus on minimising traction time.
(03) 9573 9659
Hip arthroscopy is a minimally invasive surgical procedure in which a small camera and fine instruments are inserted into the hip joint through small incisions. Modern advances in instrumentation and imaging have made it a highly effective tool for treating a wide range of hip conditions that were previously difficult to access without open surgery. Mr Balakumar is fellowship trained in hip arthroscopy and performs it regularly for paediatric, adolescent and adult patients.
Current indications for hip arthroscopy include labral tears, CAM impingement (bony or cartilaginous prominence at the femoral head-neck junction), pincer impingement (over-coverage of the socket rim), hip dysplasia in conjunction with PAO, cartilage tears or lesions, ligamentum teres injuries, snapping hip syndrome, iliopsoas bursitis, loose bodies within the joint (such as in synovial chondromatosis), and osteochondritis dissecans. In selected cases it can also be used in the assessment of early osteonecrosis of the femoral head, and to temporise symptoms of mild to moderate hip osteoarthritis with associated mechanical symptoms.
The hip is a deep, well-constrained joint surrounded by multiple ligaments and muscles. Unlike the knee, it requires traction to create enough space for the camera and instruments to enter the joint safely. Traction can be applied with the patient on their side or on their back, and Mr Balakumar uses the position that gives the best access for the specific procedure required.
Traction is associated with risks including pressure areas, numbness in the groin, and nerve or vessel injury. These risks are directly related to the duration and magnitude of traction applied. Mr Balakumar minimises traction time by using other techniques including patient positioning and gravity to assist access, and by planning the sequence of the procedure to keep traction to the minimum necessary.
In CAM impingement, the abnormal prominence on the femoral head-neck junction is carefully removed using a high-speed burr. This reshaping is performed under fluoroscopic guidance to verify the correct amount of bone is removed and that normal head-neck architecture is restored.
In pincer impingement, the over-covering rim of the acetabulum is carefully trimmed to reduce contact between the rim and the femoral neck, without destabilising the labrum or removing excessive bone.
The labrum is assessed at arthroscopy. Where a tear is present, repair using sutures anchored to the acetabular rim is the preferred approach as it preserves the native tissue. In cases where the labrum is too damaged to repair, labral reconstruction using a tendon graft may be appropriate.
Before performing hip arthroscopy, Mr Balakumar often orders a specialised MRI sequence called dGEMRIC, which provides a quantitative assessment of cartilage health. This helps determine whether the patient is a suitable candidate for joint preservation surgery, or whether the degree of cartilage damage means that arthroscopy is unlikely to produce a good result. He uses this in collaboration with radiologists at the Royal Children’s Hospital Melbourne and Melbourne Radiology Clinic.
Most patients go home on the day of the procedure or the following morning. Crutches are used for two to four weeks and physiotherapy begins immediately. Return to office work is typically possible within one to two weeks. Return to sport takes three to six months depending on the extent of the procedure.
Hip arthroscopy is a technically demanding procedure. Risks include infection, nerve injury (particularly traction-related), portal site complications, fluid extravasation and failure to fully resolve symptoms. Mr Balakumar discusses these in detail at the consultation.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
A procedure in which the femur is cut and repositioned to correct abnormal alignment around the hip or knee. Used in both paediatric and adult patients as part of joint preservation surgery.
The gold standard surgical treatment for hip dysplasia in adolescents and adults with preserved joint cartilage. Mr Balakumar trained in this technically demanding procedure at Harvard’s Children’s Hospital Boston.
An alternative to total hip replacement in which the femoral head is capped rather than removed. Suitable for a carefully selected group of younger, active patients with end-stage hip arthritis.
An open procedure allowing complete access to all surfaces of the hip joint. Used for complex conditions that cannot be adequately addressed through arthroscopy alone.
Melbourne Orthopaedic Group is home to a team of experienced orthopaedic surgeons, providing comprehensive care for sports injuries and orthopaedic conditions. Whether it’s joint replacement or sports injuries, our specialists provide comprehensive orthopaedic care.
