Hip arthroscopy, more correctly arthroscopic hip surgery, is a minimally invasive surgery in which through two or three small incisions of 1.5 to 2 centimeters, the hip joint is approached and various types of hip problems are solved.
Differences between arthroscopy and arthroplasty
As it is a minimally invasive surgery, soft tissue dissection is minimal, making the surgery less painful and allowing for a faster recovery. In addition, it is a highly technical and technically complex surgery that requires significant experience on the part of the surgeon and extensive and sophisticated material support (traction table, arthroscopy tower, image intensifier, arthroscopy motor with different terminals, radiofrequency vaporizer, special cannulas and forceps, bone anchors, etc.).
In the case of hip arthroscopy, being a minimally invasive surgery, a minimal approach and minimal dissection is performed. Hip arthroplasty (replacement), if any, is a joint replacement surgery that repairs the joint and replaces it to a greater or lesser degree. The approach to the joint is “conventional” and larger than the small approaches performed in arthroscopy. In addition, it is associated with greater postoperative pain and greater blood loss, requiring a transfusion, although the results are very satisfactory in almost all cases. Simplifying a lot, arthroscopy is a conservative surgery and arthroplasty is a substitutive surgery.
For whom is it indicated?
Basically, it is indicated in patients suffering from femoro-acetabular impingement, whether CAM (femoral deformity), PINCER (acetabular deformity) or MIXED (deformity in femur and acetabulum). It is also used in patients with lesions of the labrum (fibrocartilage that surrounds the entrance to the acetabular cavity and that contributes to seal and stabilize the hip joint), even if they do not have deformities of the articular ends. It is also used in the treatment of synovitis, articular free bodies and sometimes also in hip pain of unknown origin.
The only way to know whether arthroscopic surgery is indicated or not is to carefully evaluate the patient and assess whether we think it will improve or not. There are really many factors to take into account:
- Pathology presented by the patient.
- Degree of functional limitation.
- Degree of joint involvement.
- Other factors.
That is to say, it is necessary to make an absolutely personalized and detailed assessment of each situation.
The main diagnostic problem is the topographic diagnosis. That is to say, the pain really originates in the hip or it can have another origin:
- Serous bursae
- Tendons
- Neighboring muscular structures
- Pelvic organs
- Lumbo-sacral spine
Another problem in deciding whether the indication is suitable is determined by the degree of evolution of the pathology. This is especially important in cases of CAM-type deformities that usually show symptoms when they are already very advanced.
If the diagnosis is correct, the technique is refined and the situation of the joint is not bad, the results are very satisfactory in a percentage of 80-90% of the cases. And as we have already said, the postoperative period is not painful and blood loss is negligible, although the total recovery process can be long.
Preventing hip pain is possible
It is certainly possible to do many things to prevent and/or control hip pain without surgery of any kind. As in all musculoskeletal pathologies, it is necessary to personalize the measures to be followed.
As a general rule, weight control, control of the activity we do, the physical activity practiced according to our physical level and avoiding activities considered harmful: stairs, low chairs, prolonged standing, sedentary lifestyle, etc., will help us to improve our hip pain and prolong the “useful” life of the hip.
The importance of asking for help
When we have pain in the inguinal region, thigh (anterior face or internal face, commonly known as the area of the adductors), gluteal region or knee, without obvious cause and after treatment with rest and reasonable anti-inflammatory drugs, it is advisable to visit a specialist. Many times what harms the evolution of the hip is to insist on a treatment that is not giving us results.
It is also very common and not advisable to go to a physical therapist without a previous diagnosis, since many hip pains do not originate in the hip or if they do, the pain begins to radiate in the thigh area, adductors and knee.