William Kurtz, M.D. - Joint Replacement Surgeon
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Hip Arthroscopy :: Knee Arthroscopy :: Shoulder Arthroscopy

Hip Arthroscopy

Indications for a hip scope:

Hip pain resulting from tears of the acetabular labrum or as a diagnostic tool.

Discussion:

The acetabular labrum is a horseshoe-shaped fibrocartilaginous structure attached to the periphery of the acetabulum that adds depth to the hip joint. It is a different type of cartilage than that which "cushions" the hip joint. Its function is to provide additional stability to the hip when moving the hip to its upper limit of motion.

The labrum can tear suddenly as a result of a fall or by moving the hip to its upper limits of motion or it can tear gradually from repetitive stresses. The patient may experience catching or clicking associated with discomfort on the front of the hip. Pain may worsen with long periods of sitting. Only 1/3 of patients recall trauma to the hip joint.

A labral tear can often occur if the hip socket is shallow or as a result of impingement. In this condition, the labrum is trying to compensate for insufficient bone covering the femoral head and it is bearing the majority of the load. In this type of "hip dysplasia", repairing the labral tear is not indicated as it will not solve the underlying cause (i.e., shallow socket) and an osteotomy needs to be considered. It should be noted that pure labral tears with no underlying hip malformation are rare in comparison to other conditions that necessitate hip reconstruction.

Diagnosis:

On physical exam, a labral tear manifests itself when the range of motion is more than normal and there is pain either with hip flexion, internal rotation and adduction or extension in external rotation. General radiographs are initially reviewed to rule out hip dysplasia followed by an MRI with contrast injection (gadolinium enhancement). The MRI cannot detect all labral tears and, in fact, a “false-negative” result occurs in about 10% of cases.

Treatment and Post-Operative Recovery:

If the MRI is positive and the hip joint is properly formed then a hip arthroscopy is the procedure of choice. A hip arthroscopy can address the labral tear resulting in pain relief and a return to near normal function. Some patients (5%) do not experience full pain relief because of damage to the cartilage lining. The procedure is performed on an outpatient basis. The recovery is relatively simple in that the patient is on crutches for 1-2 weeks and they are able to bear full weight on the operated leg. 70%-90% of patients with labral tears who undergo hip arthroscopy report good to excellent results at three years.

If the MRI is negative yet hip pain persists, the hip is injected with a local anesthetic (marcaine) to confirm that the hip is the source of the pain. If the pain relief is complete, then an arthroscopy is still indicated since the MRI may not have detected the tear.

 

William Kurtz, M.D. - Joint Replacement Surgeon William Kurtz, M.D. - Joint Replacement Surgeon
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