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The arthroscopic treatment of Hip Impingement has recently been reassessed by the National Institute for Health & Clinical Excellence (NICE). This guidance is now published on the website.

What is Hip Arthroscopy
Hip arthroscopy is performed under general anaesthetic and through small incisions using a camera to visualize the inside of the hip joint. Using traction to pull the hip slightly out of joint and using a few small incisions (about 1 centimetre each) your surgeon will insert a camera into one incision, and small instruments through the other incisions. Using this technique, many causes of hip pain can be treated which in years gone by were not even recognised, least of all treated.

What is the benefit of hip arthroscopy compared to open surgery?
It is much less invasive than traditional hip surgery.
This means:
Smaller incisions
Earlier rehabilitation
Short hospital stay
Early return to work and sport
Unfortunately, the range of conditions able to be treated by hip arthroscopy are limited, but there is a definite and increasing place for the procedure amongst the range of treatment options available for hip disease.

What conditions can be treated with hip arthroscopy?

Cam Hip Impingement
When the ball of the hip has an oval shape rather than being perfectly round, it can jam inside the edge of the round socket as you bend your hip up. This deformity can frequently be treated using hip arthroscopy, avoiding the need to open the entire hip joint for the reshaping procedure. This is by far the most common cause of hip problems in younger patients and  is therefore the most commonly undertaken procedure arthroscopically. This condition is often associated with a tear of the labrum and damage to the lining cartilage of the hip socket.

Labral Tear
The labrum of the hip is a cuff of thick tissue that surround the rim of the hip socket. The labrum helps to support the hip joint, lubricates it and acts as a bumper between the ball and socket as the hip bends. When a labral tear of the hip occurs, a piece of this tissue can become pinched in the joint causing pain and catching sensations.

Pincer Hip Impingement
When the front edge of the hip socket overlaps the front of the hip joint too far, the ball can catch against the edge of the socket causing labral damage and damage to the cartilage at the edge of the hip socket. This is more common in women than men and may be able to be treated using hip arthroscopy in some cases.

Loose Bodies
Loose bodies are pieces of cartilage that form within the joint. They look like small marbles floating within the joint space. These loose bodies can become caught within the hip during movements.

Snapping Hip Syndrome Snapping hip syndrome has several causes, some of which can be treated with hip arthroscopy. If something is catching within the hip joint, hip arthroscopy can be used to relieve this snapping. Also, hip arthroscopy can be used to perform a psoas tendon release in cases of internal snapping hip syndrome.

Cartilage Damage
In patients with focal cartilage damage, meaning not widespread arthritis, hip arthroscopy may be helpful. These patients may sustain an injury causing a piece of cartilage to break away from the surface of the bone. These patients may benefit from removal of that piece of cartilage.

Early Arthritis
This is a controversial topic, as patients who have arthritis pain generally will not benefit from a hip arthroscopy. The patients who tend to benefit have specific finding of impingement (pinching) within the hip joint, and may benefit from removal of the bone spurs causing this impingement. This is only possible in the very early stages of arthritis, and even then may not offer relief of symptoms.

What are the possible complications from hip arthroscopy?
The most concerning complications of hip arthroscopy have to do with several important nerves and blood vessels that surround the joint.
Nerve injury is uncommon, but can be a significant problem. The most commonly affected nerves include the sciatic nerve, the femoral nerve, the lateral femoral cutaneous nerve (sensation to the thigh), and the pudendal nerve.
Injury to any of the nerves can cause pain and weakness as well as other problems.
It is quite common to experience some numbness in the perineal area (and in the penis in men) for a short time after the procedure. This is due to the pressure required to traction the hip out of joint to perform the procedure. This usually recovers in a few days, but may take up to 6 weeks to fully recover. There is a very small risk of longer term altered sensation in this area.

Other possible complications from hip arthroscopy include potential injury to normal structures within the hip joint, infection, and continued pain after the surgery. The rate of these complications is low, but patients need to understand the potential prior to undergoing a hip arthroscopy.
It is estimated that 10% of patients will have a complication of some sort or undergo an unsuccessful hip arthroscopy which does not improve pain levels.

The benefit of hip arthroscopy is that the recovery is much simpler than for open hip surgery. Patients can typically put as much weight as tolerated on the hip immediately following surgery unless specifically restricted by your surgeon.

In the first weeks after surgery, patients’ work on regaining motion around the joint, and gentle strengthening exercises. Typically, patients work with a physical therapist for assistance with these exercises and stretches.

Patient’s should not drive for 48 hours following the procedure to ensure that the anaesthetic is cleared from their circulation.
Those undertaking non manual work may return to work any time from 10 days following the procedure. Those undertaking manual work may require 2 to 6 weeks off work for recovery.

Most patients can begin light activities (cycling, swimming) within a few weeks. Athletes most often take about 12 weeks for recovery but there are specific procedures that may require a more lengthy rehabilitation.