SICOT e-Newsletter

Issue No. 2 - November 2008

Editorial - Hip Arthroscopy, a New Era

Dr Hatem Said, Young Surgeons Committee Chairman

The field of Arthroscopy has developed greatly in recent years. It has improved our management of joint problems, with better diagnosis and treatment. It started with knee arthroscopy, which has become part of the general orthopaedic training.

The arthroscopists moved on to other joints such as the shoulder, elbow and wrist. Arthroscopy in these joints mostly provided a minimally invasive tool to treat problems which were being dealt with by open surgery. Although, in the shoulder some procedures, like SLAP lesions, would have been missed by open surgery.

With the introduction of hip arthroscopy, a new era has materialised, where lesions commonly missed or treated such as ‘hip sprains’, the causes of which have been identified, e.g. Labral tears. For other lesions like Ligamentum teres tears, small chondral lesions, or small bone fragments post hip dislocations are being diagnosed and treated.

With a better understanding of Femoroacetabular impingement, popularised by Ganz, the need for hip arthroscopy exponentially increased. Instead of doing an open hip dislocation to treat the Cam or Pincer impingement, with the risk of avascular necrosis of the femoral head, all these procedures are done arthroscopically, through a few portals.

Only a few clinical tests can identify the hip problem; the labral stress test, anterior and posterior impingement tests, resisted straight leg raise and the FABER tests. The main diagnostic tools are plain AP, lateral and false lateral X-rays and MRI arthrography.

Hip arthroscopy is still in its infancy, with only a small number of surgeons around the world performing it on a weekly basis. Although the short term results are very good, the long term results and studies have still to be proven, and whether it can really be a prophylaxis for hip osteoarthritis is still the big question!

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