Mr Mark Ashworth FRCS (Orth)
Consultant Orthopaedic Surgeon
HIP AND KNEE PAIN
Hip arthroscopy can be either diagnostic or therapeutic:-
Diagnostic- If local anaesthetic injection abolished the pain yet there is uncertainty about the diagnosis/cause of the hip pain despite investigation such as X-ray, MRI, CT, Bone scan etc. then hip arthroscopy is a useful additional investigation. The diagnosis of a wave sign in the articular acetabular cartilage is very helpful in managing a dysplastic hip as it helps with prognosis. If injection therapies are not working it can point the way to a peri-acetabular osteotomy or in older patients the need for a hip replacement. Mr Ashworth has now operated on over 30 patients (mainly middle aged female) who have been told their hip is normal on X-ray wher the shallow front wall of the acetabulum was missed. This group have had very pleasing outcomes with a low complication rate (such as psoas impingement due to the very shallow front acetabular wall meaning the psoas tendon catches on the rim of the new acetabular component).
Therapeutic- Hip arthroscopy can treat isolated labral and chondral injuries as well as femoro-acetabular impingement (both cam and pincer). It is used to remove loose bodies and can treat psoas impingement such as after hip replacement, without entering the new hip joint and scratching the new femoral head.
As the hip is deep inside the body, the operation is performed with X-ray guidance. A traction operating table is used to distract the hip to create enough space to introduce the arthroscope into the hip.
This surgery is nearly always performed as a day-case
Bruising/injury to perineum
Injury to a nerve (usually temporary -pudendal n or lateral cutaneous n of the thigh)
In tight hips it is not always possible to do all the planned surgery and scuffing is seen more often due to the difficulty of maneuvering the arthroscope
Temporary flare of pain, most settle but occasionally a cortisone injection is needed after the 6 week review to help this flare settle
Failure to resolve the original pain and thus the need for further treatment up to and including hip replacement surgery