Hip arthroscopy is a recent technique, developing rapidly over the past fifteen years, allowing for the repair of the joint when it is not yet too damaged. Thus, it is part of the treatments that preserve the native hip.
Indeed, we are increasingly realizing that at least 40% of hip osteoarthritis could be due to untreated old lesions or small anatomical defects leading to the slow and progressive destruction of the joint.
Hip-preserving surgery, notably arthroscopy, allows for the repair of these lesions and anatomical defects in patients before the joint damage becomes irreversible and hip replacement becomes the only remaining solution.
Arthroscopy involves the insertion of a camera and thin instruments into the joint to perform a surgical intervention without tissue destruction. There is no muscle cutting, and the scars are pinpoint.
This process, therefore, allows for a quicker recovery, which is why arthroscopies are most often performed on an outpatient basis.
What pathologies can be treated with hip arthroscopy?
1) Femoroacetabular Impingement (FAI):
This is a dynamic pathology, characterized by the abnormal contact of the femoral neck against the rim of the acetabulum during hip flexion and rotation. The labrum and the cartilage on this rim are repeatedly crushed, leading to their fissuring.
This contact can originate either from the presence of a bone bump on the femoral neck (cam effect), or from a too prominent acetabular rim (pincer or clamp effect). The combination of both deformities is common, referred to as a mixed impingement.
Certain sports requiring large ranges of motion are particularly prone to impingements, such as combat sports, classical dance, ballet, etc. Some professions are also predisposed, especially those requiring squatting on the ground (e.g., tilers, mechanics), or extreme prolonged or repetitive hip flexion (e.g., taxi drivers).
The procedure involves shaving the bone areas causing the impingement, at the level of the femur and/or the acetabulum, using a motorized arthroscopic burr. It is often also necessary to repair sequela lesions of the impingement, such as tears of the labrum or cartilage.
2) Labral lesions
3) Cartilage lesions
Like labral lesions, they are most often secondary to femoroacetabular impingement or hip instability. When these lesions are in their early stages, they can benefit from treatment under arthroscopy.
The possible technical procedures vary according to the indications: bone microfracture, cartilage grafting, mosaicplasty, etc.
4) Synovial pathologies
The synovial membrane lines the inner surface of all joints. It produces a lubricating fluid called synovial fluid and plays a significant biochemical and immunological role.
Certain synovial pathologies can lead to the destruction of the hip cartilage.
The most common are synovial chondromatosis (formation of cartilage "flakes" in the joint cavity) and pigmented villonodular synovitis (thickening of the synovial membrane in the form of villi and nodules). These are benign tumor pathologies in both cases, but the accompanying inflammation can be very painful and resistant to non-surgical treatment, hence the need for intervention.
Arthroscopy allows for visual diagnostic confirmation and intra-articular biopsies, as well as treatment by debridement (partial or complete depending on the pathology) of the synovial membrane.
It also allows for the removal of cartilage "flakes" from the joint cavity.
5) Hip tendinitis and tendinopathy
It's the inflammation of one or more tendons around the hip that causes your pain and discomfort. It can be a simple inflammation, or more significant lesions such as a tear or rupture of the tendon. This is then referred to as tendinopathy.
Most often, it involves the tendons of the gluteus medius, gluteus minimus, or iliopsoas.
As with the rotator cuff in the shoulder, debridement with repair of the damaged tendon can be performed either openly or by arthroscopy, depending on the type, extent, and location of the lesion. Anchors can be used if necessary to reattach the tendon to its bony insertion.
6) Hip microinstability
It involves excessive laxity of your joint, or a shallow acetabulum, leading to insufficient coverage of the femoral head, which can result in lesions of the labrum and/or cartilage.
The treatment addresses the articular capsule, which contains the ligaments stabilizing the hip and can be tightened. This procedure is known as capsular plication.
In severe cases where there is a significant coverage defect of the femoral head in a very young patient, a hip impingement surgery can be performed. This involves grafting a small bone block onto the roof of the acetabulum to increase its coverage.
Is there an alternative to surgery?
In most cases, the medical treatment of hip pain is a mandatory step.
We have a multitude of “small means” to try to control the symptoms without surgery: Avoiding traumatic movements or extreme positions, injections, PRP injections, anti-inflammatories, and painkillers, etc.
Well-conducted physical therapy can be of decisive utility: through specific work to correct certain movements, and by primarily strengthening the muscle groups that separate the bones in conflict, it can improve symptoms and avoid surgery.
If the well-followed medical treatment proves insufficient and the impact of symptoms on your physical and sports activities is significant, performing a hip arthroscopy becomes necessary.