Hip arthroscopy new way for treatment

By Kim Pil-Sung

Providing adequate diagnoses and treatments for hip disorders entails various difficulties. Examinations done frequently in the past, such as X-rays, CT scans, and MRIs, do not help greatly in providing accurate diagnoses.

Furthermore, conservative treatments either provide slow recovery times or carry higher chances of recurrence of the disease.

In addition, surgical treatments which make incisions to the joint and provide treatment have certain levels of risk. Considering these aspects, the method of hip arthroscopy is significant in that it can diagnose the condition more accurately and provide the treatment at the same time.

Arthroscopic treatment in the hip area was first reported by Burman in 1931, and it was performed clinically by Takagi in 1939. However, this particular method was not used widely among the surgeons until the 1970s. Over the past 30 years, the treatment of knee and shoulder problems with the arthroscopic method has improved significantly, and applying this to the hip has started to show positive outcomes. In the 1980s, a few surgeons like Johnson, Watanabe, and Erikson sporadically reported on hip arthroscopy. Glick, Sampson, VIlar, Byrd, and Philippon made progress on the hip arthroscopic method, and studies were carried out on the anatomical aspects.

Why was introducing the arthroscopy to the hip so difficult relative to other joints? One of the reasons is that there are many muscles surrounding the hip, and various nerves and blood vessels made it difficult for arthroscopy to approach the hip areas. However, with the development of surgical instruments and a better understanding of the anatomy of the hip, the arthroscopic treatment has been introduced and developed further to diagnose previously unexplained hip symptoms. Recently, the arthroscopic method has been applied to treat femoroacetabular impingement and the acetabular labral tear, and it is being developed to provide for even wider applications.

Minimally invasive method allows for faster recovery and minimized risks of bleeding and infection

Conventional hip surgery dislocated the femur joint and was performed by observing with the naked eye. However, this surgical method had problems of increased infection due to large skin invasion. In addition, many younger patients held back on selecting this method due to the large scar left after the surgery. For such patients, the hip arthroscopic method can be quite effective.

Hip arthroscopy is performed by making 2–3 incisions with the size of 5–6 mm. The arthroscopy is inserted into the incision areas, and the surgeon sees the site through the monitor to fix the labral tear or to treat the damaged areas. As the condition of the joint is carefully examined through the arthroscopy, this method is effective in providing both accurate diagnoses and treatments. Furthermore, as the incision is less than 1cm, the associated risks from bleeding and infection are minimized, and this method provides patients fast recovery times.

Hip arthroscopy is usually performed to provide diagnoses for patients with hip pain, to diagnose and treat the labral tear, to remove foreign substance in the joint, and to treat early stage hip arthritis, damaged ligamentumteres, and other hip disorders. These days, hip arthroscopy is applied not only to treat disorders within the joint, but also to treat those other than articular capsules. A snapping hip and pain in the back and side of the hip are the ones being newly treated by the arthroscopic method.

As mentioned above, hip arthroscopy is being used to treat a wide variety of hip disorders; it has been proven to be a safe and effective method. Furthermore, this treatment method is continually progressing to bring better results, and it is being studied by many orthopedic surgeons. However, this treatment should be performed only based on each individual’s condition. Also, hip arthroscopy requires high levels of skillsets to be performed accurately. Thus, patients should consult with surgeons who have extensive experience in hip arthroscopy treatment.

The writer is specialist of orthopedic surgery at Bumin Hospital Seoul in Gangseo District.