Hip Arthroscopy

Hip arthroscopy is an advanced technique in keyhole surgery with modern instrumentation that has revolutionized treatment of disorders around the hip. Dr Balakumar is fellowship trained in hip arthroscopy and other techniques around the hip.

The management of hip injuries in children and adults has evolved significantly in the past few years with the advancement of arthroscopic techniques. The application of minimally invasive surgical techniques has allowed relatively rapid returns to sporting activity and to normal lifestyle.

Recent advancements in both hip arthroscopy and magnetic resonance imaging (MRI) have allowed several sources of joint abnormalities that result in chronic and disabling hip symptoms to be identified. In the past these conditions were untreated as it was not clear where the symptoms were arising from. Dr Balakumar often orders MRI scans with dGEMRIC (delayed gadolinium enhanced Magnetic Resonance Imaging) allowing for cartilage mapping in both a quantitative and qualitative fashion. This allows him to assess the state of the existing cartilage and prognosticate the chances of success with joint preservation surgery (i.e. arthroscopy or osteotomy).

Current indications for hip arthroscopy include:

• the presence of symptomatic acetabular labral tears
• Cam lesions (bony or cartilaginous bumps)
• Pincer lesions (overcovering of the socket)
• dysplasia (undercovering)
• cartilage tears or lesions
• osteochondritis dissecans (cartilage and bone microfracture), ligamentum teres injuries
• Snapping hip syndrome (tendons flicking over the hip)
• iliopsoas bursitis
• loose bodies (for example, synovial chondromatosis).

Other indications may include assessment of osteonecrosis of the femoral head (loss of blood supply), rheumatoid arthritis, crystalline hip arthropathy (gout and pseudogout), infection, and posttraumatic intraarticular debris. In rare cases, hip arthroscopy can be used to temporize the symptoms of mild-to-moderate hip osteoarthritis with associated mechanical symptoms.

Hip arthroscopy is technically challenging. It has to be performed by someone who is well trained in the technique (preferably fellowship trained)  as the hip is a well constrained joint and arthroscopy by a novice may result in considerable collateral damage to the joint.

Unlike arthroscopy in other joints, the hip is deep and surrounded by multiple ligaments and muscles. As a result hip arthroscopy is done under traction (by stretching the leg from the body). This can be done on the side or back. Each has its advantages and disadvantages.  The traction is done to provide adequate space for the scope (camera) and instruments to enter the joint safely. The complications of the traction are numerous including pressure areas, groin numbness, nerve injury and vessel injury. In women there have been multiple reported cases of necrosis (skin death) to the labia.

Dr.Balakumar performs hip arthroscopy minimizing traction time, utilizing other techniques such as gravity and the patient’s body weight thus minimizing these complications.

Recovery

Most patients who have hip arthroscopy with Dr.Balakumar can go home the next day. They will expect a 6 week to 3 month recovery period. Patients will continue to improve for up to 6 months to a year. Patients may notice inconsistencies in post operative regimes from surgeon to surgeon. This depends on the pathologies being treated and the amount of bony work that is performed. This is because most children and adults with hip conditions often have anatomical variations that predisposes them to injuries around their hip. The human hip was also designed for different physiological loads than what we subject it to in modern society.

Dr.Balakumar will tailor your treatment to your lifestyle and this often includes addressing the underlying bony abnormality not just the presenting pathology.