Hip arthroscopy update

Abstract

The management of hip injuries in the athlete has evolved significantly in the past few years with the advancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in recreational and elite athletes alike. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular pathology that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and thus, left untreated. Current indications for hip arthroscopy include management of labral tears, osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition, patients with long-standing, unresolved hip joint pain and positive physical findings may benefit from arthroscopic evaluation. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after surgical intervention. Strict attention to thorough diagnostic examination, detailed imaging, and adherence to safe and reproducible surgical techniques, as described in this review, are essential for the success of this procedure.

Figures

Fig. 1

Anatomical constraints of the hip. The anterior ligamentous constraints of the hip are seen in the anterior view and include the iliofemoral and pubofemoral ligaments. The ischiofemoral ligament is the primary posterior restraint. (Reprinted with permission from Am J Sports Med [29])

Fig. 2

a and b Flexible instruments allow for significantly improved access to most structures within the hip joint during routine arthroscopy. (Reprinted with permission from Am J Sports Med [29])

Fig. 3

Diagnostic algorithm for categorizing and treating nonarthritic hip pain

Fig. 4

Typical appearance of a labral tear in the anterior superior weight-bearing zone

Fig. 5

View of the normal suction seal of the labrum on the femoral head with the traction released

Fig. 6

Debridement of labral tears (a) should remove all degenerative tissue and leave as much viable tissue as possible (b)

Fig. 7

Arthroscopic labral repair. The labrum is seen detached off the bony acetabulum (a) and is repaired back using a suture anchor and mattress suture around the labral tissue (b)

Fig. 8

Head-neck junction osteophyte

Fig. 9

a Preoperative and b postoperative arthroscopy images of the peripheral compartment of a hip treated for femoroacetabular impingement. Removal of the osteophyte can be very effectively accomplished arthroscopically (b)

Fig. 10

a Microfracture of a grade 4 chondral lesion on the anterosuperior acetabular rim. b Microfracture holes are evenly spaced throughout to promote fibrocartilage growth within the focal chondral defect