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Hip arthroscopy or a 'Hip scope' or 'Keyhole surgery of the Hip' is a minimally invasive procedure in which the hip joint can be operated on using 2-3 small incisions, approximately 1.5 - 2 cm each, instead of a more invasive open surgery.
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Several hip pathologies such as hip impingement, labral tears, bony or cartilaginous loose bodies or defects and tendonitis can be addressed by hip arthroscopy.
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This procedure is usually done under General anaesthesia either as a day-case procedure or one overnight stay in the hospital. Hip arthroscopy is performed using a special table to distract the leg and hip joint. This temporary distraction is necessary for the camera and the instruments to pass through the small incisions without damaging the cartilage of the hip joint. The joint is kept inflated by continuous flow of Normal Saline, providing excellent visualisation of the joint. .X-rays are used during the procedure to ensure that the instruments and the camera are inserted properly. A variety of 'shavers' and are available to cut away or debride the frayed cartilage or torn labrum (soft cartilage rim around the edge of the socket). Some labral tears can even be repaired using special anchors. Bony burrs are used to shave away the bumps of the bone that cause hip impingement. In addition, hip arthroscopy can utilised to remove any loose bodies and also to perform 'Microfracture' which is a technique used to drill holes into patches of bare bone where the cartilage has been lost in order to promote formation of new false cartilage.
Following the surgery, patients are assessed by a physiotherapist and given crutches for 1-2 weeks to protect the hip. The patient begins a physiotherapy programme to improve the strength and the range of motion of the hip. Patients are given adequate analgesia for 2 weeks after the surgery and are advised to take 2 weeks off work. Some patients with more manual jobs may need further 1-2 weeks to recover before going back to work. The patients usually resume normal activities around 6 weeks. You can start going to the gym from 4-6 weeks but it can take 4-6 months for one to experience no soreness or pain following physical activity.
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Recent studies have shown that 85-90% of patients return to sports and other physical activities at the level they were at before their onset of hip pain and impingement. The majority of patients clearly get better, but it is not yet clear to what extent the procedure stops the course of arthritis.
Hip arthroscopy is a relatively safe procedure but as in any surgery there is a small risk of infection, blood clots, nerve and blood vessel injury and fracture. Some of the specific risks are related to the use of traction required to distract and open up the hip joint. These include temporary numbness in the groin and/or thigh and muscle and soft tissue pain around the hip and thigh as a result of prolonged traction.
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Mr Jalgaonkar specialises in hip arthroscopy and is one of the few surgeons registered on the Non Arthroplasty Hip Register (NAHR) and submits his data/outcomes regularly. NAHR is a National register of operations on, or around the hip, aimed to improve further the quality of hip surgery in the UK. This register was set up by the British Hip Society to monitor the outcome for patients of all types of operations on the hip other than hip replacements and operations carried as a consequence of acute trauma to the hip.
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