General information about hip arthroscopy for clinicians, allied professionals and patients
What is hip arthroscopy?
- Hip arthroscopy is a newly developed surgical technique which is used to treat many specific types of bony and soft-tissue hip problems.
- It uses a ‘keyhole’ technique (similar to the knee) to visualise and treat painful conditions in and around the hip joint.
What sort of conditions can be treated?
- Loose bodies - removal
- Femoroacetabular impingement (FAI) – Excision of impingement lesion
- Labral tears – repair or debridement
- Cartliage damage – microfracture repair, chondroplasty or debridement
- Iliopsoas tendonitis – debridement or release
- Synovitis – Synovectomy
- Ligamentum teres tears – Debridement
- Early osteoarthritis – Debridement
- Many of these conditions are similar to mechanical conditions which exist in other joints (such as the knee) and have been successfully treated by arthroscopic methods for many years, some however, are specific to the hip.
What causes these conditions?
- Some of these conditions are caused by sporting injury such as running, ball sports (soccer, gaelic football, rugby), athletes (hurdlers, long jumpers), dancers, personal trainers, gymnasts, jockeys etc.
- Some are related to natural anatomical variations within the hip joint such as, hip dysplasia, acetabular retroversion, coxa vara, coxa magna, or abnormal bony architecture, for example Perthes disease, slipped capital femoral epiphysis, or fracture.
Other conditions are often due to natural age related degeneration.
What does ‘hip arthroscopy’ entail?
- A surgical procedure, usually carried out as a day case under general anaesthesia.
- Several ‘keyholes’ are made in the side of the hip which are used to establish portals into the ‘ball and socket’ of the hip joint. Space is made between the ball and socket by distracting the joint by traction on the foot and ankle.
- A video camera inserted through each of the portals can see around the interior of the hip joint and femoral neck. Surgical instruments are inserted through the other keyholes to perform various operative procedures.
- The portals are stitched closed and filled with anaesthetic before return to the day-case ward and then home.
- Patients generally get home the same day after a four-hour recovery on the ward. Crutches and simple painkillers will be required.
What is the expected recovery?
- The recovery period is strongly dictated by the types of procedures required at hip arthroscopy. Patients requiring relatively minor procedures will generally get home on crutches for four to five days and return to work within two weeks. Patients requiring multiple procedures will need crutches for four weeks and longer time off work to allow the repaired areas to heal. Return to labour intensive work will take longer than desk based.
- Rehabilitation under the close supervision of a physiotherapist is crucial to optimal recovery
- The rehabilitation program extends for twelve weeks and is an essential part of the recovery from surgery and will optimise return of function and sporting ability.
What are the success rates of surgery?
- The success of the procedure is dependent on the underlying pathology in the hip.
- Patients with specific soft tissue pathology around the hip tend to improve better than patients with degenerate conditions
I think I have a hip problem, how should I go about getting in contact with a qualified hip surgeon?
- Your first call should be with your family doctor, who will take a full history, perform a clinical examination and may refer you for simple investigations such as an x-ray.
- He may refer you to a physiotherapist and recommend some of the non-operative alternatives mentioned previously. As many family doctors have little experience in this field, it may be necessary for him to refer you to a ‘sports injury’ clinic or an ‘orthopaedic’ clinic.
- Further investigations are usual
- A 3-D reconstructed CT scan
- MRI scan
- MR arthrogram
- A 3-D reconstructed CT scan
- Local policies vary as to the investigation chosen, but the referring doctor should use to information gained to determine whether you need to be referred to an orthopaedic surgeon with specialist interest in young adult hips and sports hip surgery.
Hip arthroscopy is highly technically demanding surgery and should only be carried out by surgeons fully trained and experienced in this technique.
Mr Jonathan Bunn
- Locum Consultant orthopaedic surgeon
- Craigavon Area Hospital, Northern Ireland
- Specialist in hip & knee arthroscopic sports surgery, reconstruction and joint replacement
- Mb BCh BAO FRCS (Trauma & Orthopaedics) PhD
About the surgeon
- Belfast educated and trained at Queens University, qualified as a doctor in 1995.
- Awarded Membership of the Royal College of Surgeons 1998.
- Awarded PhD in 2003 at Queens, Belfast for pioneering research into fracture healing following high-energy injuries.
- Awarded Fellowship of the Royal College of Surgeons of England 2006.
- Ling Hip Fellowship, Royal Devon and Exeter Hospital, UK
- Bartlett Knee fellowship, Melbourne, Australia
- Villar Hip arthroscopy fellowship, The Wellington Hospital, London, UK
Main surgical interests
- Sporting hip injuries, hip arthroscopy and reconstructive surgery of the hip in young adult patients
- Degenerative hip conditions (arthritis) in young adults, hip resurfacing and joint replacement surgery
- Sporting and traumatic knee injuries, knee arthroscopy and reconstruction
- Degenerative knee conditions (arthritis) partial knee replacement and total knee replacement
- For more information about hip resurfacing, hip replacement, knee arthroscopy, knee reconstruction, partial knee replacement and total knee replacement please follow the link.(Link to other procedures page)
- Former Senior men’s eights Irish National Champion, Rowing
- National and international rowing career spanning 10 years
- Since bowing out of rowing I have taken up triathlon, competing at Olympic distance and half Iron-man events around Ireland
- I also enjoy watersports, surfing and motor racing - Read more