John Tenny MD PA

Many conditions can cause hip pain. Sports injuries can damage cartilage and ligaments. Not too many years ago, most adult hip pain was treated with medication, therapy, or joint replacement. Over the past decade, hip arthroscopy has evolved to one of the most important diagnostic and therapeutic tools for the orthopedic surgeon managing hip problems.

You can think of the hip as a ball and socket joint with incredible mobility. Like all joints, the ball and socket are lined with cartilage, however, the hip is somewhat unique in that the socket has an outer rim of flexible cartilage called the labrum which gradually merges with the joint capsule. The main function of the labrum is to maintain a seal around the ball joint to keep the normal synovial fluid in the joint. In a properly functioning hip, the cartilage is separated by a synovial fluid layer. It is like having two pieces of glass with oil between them. As long as the oil is between the glass plates, there is very little friction.

Treatment of labral tears is an important indication for hip arthroscopy. Repairing a torn labrum (shown in picture) can not only eliminate hip pain, but also delay and possibly eliminate the development of arthritis. Sometimes the body forms extra bone along the margins of the socket or the ball of the hip joint which can cause pain with motion. This extra bone impinges on surrounding bone or soft tissue. Hip Arthroscopy can be used to remove the extra bone and eliminate pain. Tendons can rub on structures about the hip and cause problems. Pain in the front of the hip can be caused by the iliopsoas or sometimes just called the psoas tendon. This tendon can rub on bone, or sometimes even a replaced hip joint, and cause significant symptoms. Hip arthroscopy can be used to release this tendon. For the first few weeks after the release, the hip is weak, however, as the elongated tendon heals, the hip strengthens.

Hip arthroscopy has many other indications, such as removal of loose bodies and inflamed synovium. Many people develop trochanteric bursitis which causes pain along the outside of the hip. This condition usually responds to rest, injections, and therapy, however, sometimes pain persists despite these modalities. An arthroscope can be use to remove the inflamed trochanteric bursa and the pain that has lasted for months or even years eliminated.

One major benefit of hip arthroscopy over an open procedure, is that patients recover much quicker with less pain. People have several small puncture wounds rather than a large incision. Hip arthroscopy is performed as a day surgery. Patients usually use crutches for one to six weeks and athletes usually return to sports by 12 weeks.