Hip arthroscopy has recently been recognized as an efficient technique for treating femoroacetabular impingement and repair labral and cartilage lesions associated with it. Arthroscopy in hip dysplasia has a limited role because usually in this case patients require a procedure for re-orientation of the acetabulum (consulte a secção ""Bernese" Periacetabular Osteotomy").
Indication for arthroscopy depends on the morphology of the hip. The hips with normal or not very pronounced acetabular coverage are more suited to this type of procedure. Each case must be carefully assessed in order to decide the best surgical approach.
Access to the joint is usually done with distraction of the hip using suitable equipment (distractor) with protection of limbs and through two or three entry points (portals - small incisions in the skin). The first entry portal is established with the aid of X-ray, the remaining under the direct visual control from within the joint. In arthroscopy of the hip are used specific instruments (fig. 1).
|fig 1: in hip arthroscopy are used optics with 70 º, small curved motorized instruments, flexible radio frequency instruments and anchors (special sutures that secure soft tissue to bone) of small size to repair the acetabular labrum.|
Hip arthroscopy allows a very fast recovery, typically with a hospital stay of only one day, need to use crutches for about 2 to 3 weeks (in certain cases crutches usage time may be higher) and rapid resumption of the professional activity. Impact sports, however, should only be resumed after a few months.
During the procedure firstly is observed the central compartment (acetabular cavity) (video 1) and cartilage and labrum lesions are repaired; if there is an impingement type "pincer" excess acetabular wall can be removed.
|fig. 2: On the left the hip of a 16-year girl whit with femoro-acetabular impingement before surgery (acetabular retroversion and a non-spheric part of the femoral head).
At right, the correction after hip arthroscopy
Then is observed the peripheral compartment (outside of the acetabular cavity) and the hip can be mobilized looking to see whether there is a mechanism of cartilage damage. (see section "Perthes Disease" and video 2) e (see section "Which patients with femoroacetabular impingement can preserve their hip?").
In impingement´s as "cam" are removed the non-spherical portions of the femoral head with the aid of motorized instruments (video 2) (see section "Which patients with femoroacetabular impingement can preserve their hip?").
Hip arthroscopy is technically demanding and has a long learning curve. It should preferably be carried out by surgeons with experience and differentiation in conservative hip surgery.
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