Hip arthroscopy is a minimally invasive surgical procedure performed through small incisions (about one to two centimeters each) using a tiny camera to visualize the inside of the joint. Frequently an outpatient procedure, hip arthroscopy patients recover and resume normal activities more quickly than patients with traditional hip surgery.
Hip arthroscopy has been used to treat elite athletes and professional dancers with hip injuries, but is now available for patients with several conditions. The number of surgical centers that offer the procedure is, however, still limited, and in Southern California, Eisenhower Medical Center is one of only a handful of centers where hip arthroscopy is an option.
Matthew V.Diltz,MD, is an Orthopedic Surgeon at Eisenhower Medical Center who specializes in sports medicine. Formerly a physician to the Boston Ballet and Northeastern University,Dr.Diltz says the new procedure is most frequently used to treat conditions that require an evaluation and possible repair or removal of damaged tissue in the joint. These can include labral tears (a tear in the labrum, the thick tissue that surrounds the hip socket), and cartilage damage. It is also used to prevent the progression of early arthritis, and specifically, impingement or pinching within the hip joint.
We typically treat patients who have the beginnings of arthritis with hip arthroscopy,” says Dr.Diltz.“They are not candidates for a full hip replacement, but they are starting to have impingement, which is an abnormal friction between the ball and socket of the hip joint that causes damage to the outer labrum and eventually the cartilage.”Dr.Diltz uses a small incision to go in with a camera, determine where the bones are hitting one another and make repairs.
“Before hip arthroscopy, the only way to treat that impingement was through surgery that required a large incision, and then a breaking of the bone in order to dislocate the hip and chisel away pieces of the bone,” says Dr.Diltz.“We’d then put the hip back into place using screws. It was a major procedure with a long recovery period.Now, we can accomplish the same goal using an outpatient procedure, with much quicker recoveries.”
Dr. Diltz believes that treating impingement with hip arthroscopy can help preserve the hip joint.“One of the reasons people have early arthritis of the hip is the impingement,” explains Dr.Diltz.“If we can keep those bones from knocking together, we can hopefully preserve the hip joint longer, and perhaps prevent hip replacements later in the life. That’s the goal.”
Dr. Diltz typically keeps patients overnight following hip arthroscopy to begin movement of the joint.After 24 hours,most patients do not experience serious pain.Depending on the reason for surgery, recovery includes two to three weeks on crutches to keep pressure off of the surgical area.Most patients can begin light, nonweight- bearing activities (cycling, swimming) within a few weeks. Athletes can typically return to their sports within 12 weeks; others may require more recovery time.
“It’s important to catch impingement early, so if someone is having hip pain, or feels a click, or a catch, they should have it looked at so the joint does not begin to wear out more quickly than it should,” cautions Dr.Diltz.“If arthritis progresses too much, and an individual has lost a lot of cartilage, it’s difficult to treat it with hip arthroscopy.”