Hip arthroscopy: evolution, current practice and future developments

Abstract

Arthroscopic examination and treatment is an ever-increasing part of modern orthopaedic practice in this age of minimally invasive surgery. Arthroscopic procedures have been widespread in surgery of the knee and the shoulder for many years; however, the hip until relatively recently, has been largely neglected. Even now hip arthroscopy is not widely available; this may be due to the complexity of the procedure, the requirement of specialist equipment and a reportedly long learning curve. On the other hand, it has gone through a period of rapid growth over the last decade and is being performed in large numbers routinely in some centres around the world. Hip arthroscopy now provides excellent visualisation of not only the articular surfaces of the hip joint but also of the peritrochanteric or extra-articular space around the hip. Pathology of both the femoral head and the acetabulum along with the soft tissues of the hip, namely the ligamentum teres, the acetabular labrum, the synovial folds and synovium, is readily diagnosed. Modern techniques provide therapeutic options for a myriad of conditions and allow modulation of pathological processes early. Additionally hip arthroscopy is a relatively safe procedure with few complications and contraindications. However, the key to good outcomes is in the careful selection of patients and meticulous surgical technique. The aim of this review is to bring the reader up to date with an overview of the evolution of arthroscopy of the hip, review the current practice and explore possible future developments.

Timing in hip arthroscopy: does surgical timing change clinical results?

“…For their management, open or arthroscopic labrum repair, impinging bone excision or microfracture have been advocated [6]. There is a trend towards less invasive procedures, with high rates of success when these pathologies are treated arthroscopically [9][10][11]. The best timing for arthroscopic knee surgery reported for anterior cruciate ligament lesions is within the first year of injury [12], but there is no study describing the best timing for hip arthroscopy.…”

Arthroscopic Approach to Femoroacetabular Impingement

“…Arthroscopy is our preferred approach to an amenable deformity, as it may spare extensive soft tissue dissection, expedite recovery, and be associated with fewer complications [76][77][78]. Contraindications to hip arthroscopy in the treatment of FAI include anatomic or pathologic limitations to adequate joint distraction (severe acetabular protrusion, heterotopic ossification), femoral head osteonecrosis, posterior femoral cam-type deformity, extra-articular trochantericpelvic impingement, and advanced degenerative joint disease [79,80]. Relative contraindications may include significant posterosuperior cam-type deformity, profunda deformity, or other anatomic variants that may be technically challenging to safely access and thoroughly address arthroscopically and vary significantly based on surgeon experience and ability.…”

Effect of centre-edge angle on clinical and quality of life outcomes after arthroscopic acetabular labral debridement

“…Recent numerous research studies have reported that satisfactory clinical results in the treatments of hip labral lesions and other diseases could be achieved with the use of hip arthroscopy [5][6][7][8][9]. However, it remains unclear if labral lesions concomitant with acetabular dysplasia could achieve great clinical efficacy when treated with hip arthroscopic labral debridement.…”