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Arthroscopy is a true minimally invasive surgery in orthopaedics. It is a process of performing surgery with the use of a small specialized camera to allow visualization of the inside of the joint. This "microscopic" camera is placed through a tiny incision, which allows the surgeon to directly observe the inside of the joint, evaluate numerous key anatomic structures and helps verify the safe placement of other specialized instruments.
These special instruments are also placed through tiny incisions and will be used to perform the surgical procedure of choice. Typically, only three or four incisions are used. This form of surgery in general has been rapidly expanding in its utility over the last few decades, offering a faster, safer and far less painful alternative to many traditional methods of surgery.
Arthroscopy was first implemented for routine use in the knee, and has grown to be used in nearly every joint in the body from the hip to the fingers. It also allows for a more rapid recovery and carries fewer risks typically than the traditional open or larger surgical procedures. Most orthopaedic surgeons have received some training in general arthroscopic surgery and will use it when indicated in their practice. However, the trained sports medicine surgeon has undergone specialized and focused training in this general surgical technique and uses this as their primary surgical tool for most procedures. However, relatively few surgeons have experience in arthroscopy of the hip joint as it has traditionally been viewed as too difficult based on the shape and depth of this particular joint.
Arthroscopy of the hip joint specifically has grown rapidly in the last decade with our improved understanding of certain disorders of the hip, our technical ability and training and numerous technological advancements. Several procedures that were previously done through large incisions extending over several inches, and required a surgical dislocation of the hip, can now be performed through a few tiny incisions that are each approximately only 1/4 of an inch. This has been a significant evolution in treating various disorders in the hip joint, and has grown quickly since the late 1990s.
While significant advances have been made in orthopaedic sports medicine and the use of hip arthroscopy, there are still several limitations. Typically, patients that have advanced arthritis are not candidates for this procedure as it not only makes it technically unrealistic to safely perform, but also because our research has demonstrated that the overall outcomes after hip arthroscopy have been shown to decline dramatically in the arthritic hip. Numerous disorders, including hip impingement, labral tears, loose bodies (loose pieces of cartilage or bone fragments in the hip joint), synovitis (inflamed joint lining), and snapping hip can be treated effectively with hip arthroscopy. However, as this is a relatively new area of sports medicine, fairly few surgeons are trained to perform this type of procedure or have enough experience to have optimal outcomes and perform it safely.
The procedure itself requires the use of a specialized operating table to position the patient to apply gentle traction on the hip joint. This provides added space temporarily to the joint so that specialized instruments can be placed through tiny incisions to perform a variety of procedures. Typically, a specialized portable xray machine is also used to identify the safe location for placing these instruments. Hip arthroscopy procedures can vary from 30 minutes in duration to almost 3 hours and will involve a number of procedures at the same time.
Even though arthroscopic surgery is very safe in general, it is not completely without risk. Typical risks for arthroscopy include infection, damage to nerves and blood vessels around the joint, and incomplete resolution of pain. However, hip arthroscopy is somewhat unique and carries the additional risk to specific nerves around the hip, groin and thigh. Certain nerves in the groin can be affected by the positioning required for the surgery leading to a temporary change in sensation or numbness in the groin. This is uncommon overall and typically resolves over a few days to weeks if it does occur. This has been shown to be a function of patient positioning during surgery, length of the surgery and amount of traction used on the leg during surgery. Another risk is to a small network of nerves on the thigh that can be irritated or even cut during placement of some instruments for the surgery. This can result in temporary, or permanent numbness in a portion of the thigh. These risks are minimized in the hands of experienced surgeons and with careful attention to detail.