Hip Arthroscopy Update

The management of hip injuries in the athlete has evolved significantly in the past few years with theadvancement 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.     

Rehabilitation After Hip Arthroscopy

Rehabilitation after hip arthroscopy has not been well understood in the past. While surgical procedures continue to advance, athletes are already pushing the limits to return to competition as quickly as possible. As postoperative protocols evolve, it is essential to follow the basic guidelines of rehabilitation. Initially, soft-tissue healing constraints must be considered while focusing on controlling swelling and pain, restoring ROM, and preventing muscle atrophy. As physiological healing occurs, rehabilitation must address progressive lower-extremity strengthening, proprioceptive retraining, and sport-specific training.     

Clinical Outcomes of Hip Arthroscopy for Hip Labrum Calcification in Young and Middle‐Aged Patients

ObjectiveTo investigate the methods and outcomes of hip arthroscopy for hip labrum calcification, and to discuss the clinical, imaging, and intraoperative findings of hip labrum calcification.MethodsThis is a therapeutic case series study. From January 2015 to June 2018, 15 patients who met the inclusion and exclusion criteria were followed up for at least 2 years for an analysis on the outcomes of arthroscopy in the treatment of hip labrum calcification and the clinical, imaging, and intraoperative findings of the patients. There were eight males and seven females, with an average age of 38.9 ± 8.8 years (range, 23–50 years). The visual analog scale (VAS), the modified Harris hip score (mHSS), and the international hip outcome tool (iHOT‐12) were used to evaluate the outcomes of surgery.ResultsA total of 15 patients were followed up for at least 2 years (28.1 ± 2.9 months). The average calcified volume was 118.0 mm³ (range, 19.4–609.2 mm³) and calcified volume was related to the preoperative hip function score. Thirteen patients had pain in the groin area (86.7%). Labrum calcifications were located (according to the clock distribution) as follows: 14 patients were anterior and superior (11:00–3:00); 12 cases of femoroacetabular impingement (FAI) were observed during operation, including five cases of pincer type, two cases of cam type, and five cases of mixed type. VAS pain score means were 7.73 ± 1.28 before surgery, decreasing to 2.0 ± 0.89 and 1.73 ± 0.79 at 1 and 2 years post‐surgery, respectively. mHSS scores were 57.40 ± 6.23 before surgery and 82.10 ± 4.76 and 83.18 ± 4.07, 1 and 2 years post‐surgery, respectively; iHOT‐12 mean score pre‐surgery was 37.67 ± 4.85, increasing to 67.64 ± 5.30 and 72.18 ± 4.49, 1 and 2 years post‐surgery, respectively. Compared with preoperative values, postoperative VAS, mHSS, and iHOT‐12 scores were significantly improved (P < 0.01); iHOT‐12 scores also significantly decreased from 1 to 2 years postoperatively (P = 0.034). No patient had complications.ConclusionHip arthroscopy is an effective method for the treatment of hip labrum calcification. The size of calcification influenced preoperative symptoms and function. Long‐term irritation from FAI may be one important cause of labrum calcification.     

Hip Arthroscopy: Applications and Technique

Hip arthroscopy is infrequently performed in North America. The anatomic constraints of the joint and the lack of equipment specifically designed for this application have contributed to the lack of surgical experience. Because of the potential for significant neurovascular injury, familiarization with precise portal placement is essential. In properly selected patients, hip arthroscopy allows diagnosis of a variety of disorders. The authors believe this technique has a significant role in the treatment of acetabular labral tears, loose bodies, chondral injuries to the joint, and septic arthritis.     

Hip Arthroscopy: Surgical Indications

Successful outcomes of hip arthroscopy are most clearly dependent on selecting appropriate patients. The indications are numerous and continue to evolve. These indications are summarized in this report. The anatomic architecture of the hip region imposes unique challenges to performing this procedure. As a surgeon’s experience evolves, so will his or her indications for this operation. It is imperative to be knowledgeable about the technique, to exercise care with the procedure, and to be certain that it is being performed for proper reasons.