Arthroscopic surgery of the hip. The technique of repairing the joint before its replacement

For many decades, hip joint replacement, i.e. total joint replacement, has been performed in patients suffering from severe osteoarthritis and end-stage joint destruction. This surgery offers excellent results in combating pain and stiffness. However:

• With this technique, the joint is replaced with artificial materials that have a finite lifespan, while it is also an irreversible action on the patient's body.
• Many patients are at a relatively young age and have only small lesions on X-ray.

Thus, for a long time there was much concern about the management of these patients, who were neither candidates for joint replacement, nor could they live with chronic hip pain.

Hip arthroscopy
A constantly evolving and promising technique

Hip arthroscopy is internationally a cutting-edge technique in hip surgery that is constantly evolving and promising, while expectations are created for its use even in cases of severe cartilage lesions (the beginning of joint deterioration), the the simultaneous use of stem cellsbut also the repair of muscle and tendon damage around the hip joint.

What is the arthroscopy technique?

This gap has now been filled with the technique of arthroscopy, which has only in recent years been applied to the hip joint. With arthroscopy, a partial or complete repair of damage can be carried out with a fairly minimalist intervention, which in many cases can be done with a day's hospitalization of the patient in the clinic. It is an endoscopic technique and, as such, allows the patient to be mobilised immediately and return to daily activities.

Figure 1: Rupture of the cotyledonary cartilage of the cotyledon. Arthroscopic suturing corrects the damage and protects the joint from further deterioration.

Figure 2: Arthroscopic images of the hip: the surgeon can observe with great precision and repair multiple lesions.

Who are the best candidates for arthroscopy?

The best candidates for this procedure are relatively younger patients who do not have end-stage osteoarthritis of the hip. Usually, these are people with increased physical activity and a high percentage of moderate or even high-level athletes. Conditions that occur in these cases are:

• The femoral cam and pincer impingement (an anatomical variation in the shape of the bones of the joint)
• Rupture of the cotyledonary cartilage of the cotyledon (a structure similar to the meniscus in the knee)
• Hymenial osteochondromatosis and others, which cause chronic pain and disability in the patient, and of course do not resolve with other conservative treatment.

Figure 3: Construction problems in the bones of the joint can be corrected with the arthroscopic technique.

How is the arthroscopy procedure performed?

The entire technique is performed through small holes in the skin, through which a high-resolution camera and tools are inserted. By watching the whole procedure through a large screen, the surgeon can see smaller or larger joint damage at high magnification, and with the use of appropriate tools, can proceed to repair them. It is a very delicate technique that respects the surrounding noble elements of the hip, with minimal interference with the normal anatomy.

Figure 4: The procedure is performed through three small holes. A few hours later, the patient is very comfortable in his daily activities.

Minimal or no postoperative discomfort

The consequence is that the patient has little or no postoperative discomfort and can walk and leave the clinic very quickly. International studies have shown very good to excellent results after hip arthroscopy, with improvement in symptoms and return to vigorous physical activity in athletes at rates of over 90%.

Figure 5: A large percentage of athletes may experience hip symptoms. In a high percentage, they return to their previous sporting activity after arthroscopic treatment.

Figure 6: Hip arthroscopy "respects" and repairs the noble elements of the joint (articular cartilage, synovial bursa).

Text:
Dr. Alexandros P. Tzaveas, Orthopaedic Surgeon, Specialized in open and arthroscopic surgery of the hip

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