Hip Arthroscopy

Hip arthroscopy, which was first attempted in 1931, is not a widely used procedure. However, it offers some athletes and nonathletes a chance to resume and enjoy daily activities while avoiding invasive, open (large incision) surgery. Golfer Greg Norman, who had the procedure in 2000, has already attributed his strong return to the professional tour to hip arthroscopy.

The hip joint comprises the femoral head (ball) and the acetabulum (socket) (see illustration at right). Some of the biggest muscles in the body surround the joint. Because of this anatomy, traditional open surgery is a major procedure that can be quite painful and can require a long recovery. In some cases, you are not allowed to put weight on the operated leg for several weeks while the tissues heal. You most likely will stay in the hospital for two or more days. Therefore, hip arthroscopy offers many benefits. Doctors can use the arthroscope to view the entire hip joint through tiny incisions. After the procedure, you usually use crutches for several days but can bear some weight on the treated leg right away. In addition, you usually go home the same day that you have surgery.

What are the most common conditions treated arthroscopically?
Arthroscopy is used to diagnose and treat certain hip problems. If the source of your symptoms cannot be discovered from a physical examination and diagnostic studies, such as x-rays and magnetic resonance imaging (MRI), arthroscopy may be used. If nonsurgical treatment fails to bring improvement in your symptoms, your doctor may treat the condition arthroscopically. With arthroscopy, the doctor can remove bits of cartilage or bone that are loose in the joint. Arthroscopic surgery can also be used to repair or remove a tear in the hip cartilage (called the labrum) that is causing pain with "clicking" and "catching." This was the condition for which Greg Norman was treated.

Hip arthroscopy can also be used to perform a biopsy, to treat osteoarthritis, and to treat synovitis (the inflamed lining of the joint) such as in a person with rheumatoid arthritis.

Who should not have this procedure?
Arthroscopic surgery cannot be used to treat all problems of the hip joint. For example, arthroscopy will not help you if you have severe osteoarthritis or a hip that is stiff due to a condition such as arthrofibrosis. Your doctor will not treat you arthroscopically if you have already had several open hip surgeries.

Today, arthroscopy is used to diagnose and treat fewer conditions of the hip than other joints such as the shoulder and knee. However, most people have successful results from arthroscopic treatment.

Champ L. Baker, Jr., M.D., and Peter Hester, M.D.
Columbus, Georgia

Further reading: McCarthy JC, Day B, Busconi B. Hip arthroscopy: applications and technique. J Am Acad Orthop Surg. 1995;3(3):115-122. Kim SJ, Choi NH, Kim HJ. Operative hip arthroscopy. Clin Orthop. 1998;353:156-165.