Menu
Diagnostic hip arthroscopy is a minimally invasive surgical procedure that allows direct visualization of the hip joint through small incisions. This procedure serves both diagnostic and therapeutic purposes in managing various hip pathologies.
The procedure is performed under general anesthesia with the patient positioned supine on a traction table. Fluoroscopic guidance is essential for accurate portal placement and joint access. Standard portals include anterior, anterolateral, and posterolateral approaches, though additional portals may be utilized based on pathology location.
Joint distraction is achieved through controlled traction, creating adequate space for instrument manipulation and visualization. The arthroscope, typically 70 degrees, is introduced through the anterolateral portal, while working instruments are inserted through the anterior portal.
Systematic examination includes assessment of the central compartment (acetabular fossa, ligamentum teres, acetabular labrum, articular cartilage) and peripheral compartment (femoral head-neck junction, capsule). The surgeon evaluates for labral tears, chondral lesions, loose bodies, synovitis, and femoroacetabular impingement (FAI).
Common pathologies addressed during hip arthroscopy include labral tears, FAI, synovial disorders, chondral injuries, and ligamentum teres pathology. The procedure allows for various therapeutic interventions such as labral repair or debridement, osteoplasty for cam lesions, rim trimming for pincer lesions, and removal of loose bodies.
Advantages include minimal soft tissue disruption, enhanced visualization of intra-articular structures, faster recovery compared to open procedures, and reduced post-operative pain. The procedure typically takes 60-90 minutes, depending on pathology complexity and required interventions.
Post-operative protocols vary based on procedures performed but generally include protected weight-bearing, structured physical therapy, and gradual return to activities. Most patients can return to normal activities within 3-6 months, though athletic activities may require longer recovery periods.
Complications, while rare, may include temporary nerve irritation, infection, deep vein thrombosis, and traction-related issues. Proper patient selection, meticulous surgical technique, and appropriate post-operative care are crucial for optimal outcomes.
Success rates vary depending on underlying pathology and patient factors. Best outcomes are typically seen in patients with mechanical symptoms, minimal arthritic changes, and appropriate indications. Advanced osteoarthritis generally predicts poorer outcomes and may be better suited for arthroplasty.
Recent technological advances have expanded the scope of hip arthroscopy, allowing for more complex procedures and improved outcomes. Continued refinement of techniques and instruments has made this procedure an increasingly valuable tool in managing hip pathology, particularly in younger, active patients.
Diagnostic hip arthroscopy has emerged as a valuable tool in sports medicine for the evaluation and treatment of various hip pathologies. This minimally invasive procedure allows for direct visualization of the hip joint, providing both diagnostic and therapeutic benefits. As the understanding of hip disorders has evolved, so too has the role of arthroscopy in managing these conditions, particularly in athletes and active individuals.
Indications: Hip arthroscopy is indicated for a variety of conditions, including:
• Femoroacetabular impingement (FAI)
• Labral tears
• Chondral lesions
• Loose bodies
• Synovitis
• Ligamentum teres injuries
• Snapping hip syndrome
• Early osteoarthritis
Pre-operative Assessment: A thorough pre-operative assessment is crucial and includes:
• Detailed history and physical examination
• Imaging studies (X-rays, MRI, CT)
• Assessment of hip range of motion and strength
• Evaluation of gait and functional movements
Procedure: The procedure is typically performed under general anesthesia with the patient in either the supine or lateral position. Key steps include:
1. Joint distraction using traction
2. Portal placement (typically anterolateral, anterior, and posterolateral)
3. Systematic examination of the central and peripheral compartments
4. Diagnostic evaluation and documentation of pathology
5. Therapeutic interventions as indicated
Diagnostic Findings: Common arthroscopic findings in athletes include:
• Cam and pincer lesions in FAI
• Labral tears, often in the anterosuperior quadrant
• Chondral damage, particularly in the anterosuperior acetabulum
• Ligamentum teres tears or synovitis • Capsular laxity or instability
Therapeutic Interventions: Based on diagnostic findings, various therapeutic interventions can be performed:
• Labral repair or debridement
• Femoral osteochondroplasty for cam lesions
• Acetabular rim trimming for pincer lesions
• Microfracture or chondroplasty for chondral lesions
• Capsular plication for instability
• Ligamentum teres debridement or reconstruction
Post-operative Management: Post-operative protocols vary based on the specific procedures performed but generally include:
• Weight-bearing restrictions (often partial weight-bearing for 2-4 weeks)
• Range of motion exercises
• Progressive strengthening and neuromuscular control exercises
• Gradual return to sport-specific activities
Outcomes: Outcomes following diagnostic and therapeutic hip arthroscopy in athletes are generally favorable. Studies have shown:
• High rates of return to sport (70-90% in most series)
• Significant improvements in pain and function
• High patient satisfaction rates
Factors associated with better outcomes include:
• Younger age
• Lower BMI
• Absence of significant osteoarthritis
• Shorter duration of symptoms prior to surgery
Complications: While generally safe, potential complications of hip arthroscopy include:
• Temporary neurapraxia (most commonly of the pudendal or lateral femoral cutaneous nerves)
• Iatrogenic chondral or labral injury • Fluid extravasation
• Heterotopic ossification
• Infection (rare) • DVT (rare)
Advances and Future Directions: Recent advances in hip arthroscopy include:
• Improved understanding of hip biomechanics and pathoanatomy
• Development of advanced instrumentation and techniques
• Expanded indications, including extra-articular procedures
• Enhanced rehabilitation protocols
Future directions may include:
• Biological augmentation (e.g., stem cell therapy, growth factors)
• Improved capsular management techniques
• Refinement of indications and patient selection criteria
• Long-term outcome studies
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
