17.AUG.2016 4 MIN READ | 4 MIN READ

As the main joint connecting the legs to the torso, hip injuries can result in severe pain during movement and possible loss of mobility.

When it comes to sports injuries, we often hear of knee and ankle pain complaints, but the oft-neglected hip is similarly susceptible to pains and telling symptoms.

Our hip joint comprises of the connection between the top of the thigh bone (femur) and the pelvic bone. The top of the thigh bone, known as the femoral head, is shaped like a ball, which fits into a socket on the pelvic bone (acetabulum). There is a layer of cartilage on both surfaces to allow for smooth rotation, and there is an additional ring of cartilage (labrum) around the socket to create an airtight seal and keep the femoral head in position.

What are hip injuries?

Sports injuries to the hip area can be caused by over-rotation of the hip joint, or constant ‘stop-start’ motion that increases stress on the joint. Typically, hip injuries tend to involve cartilage surfaces of the joint or the labrum.

According to Dr Andrew Dutton, an orthopaedic surgeon currently practising at Mount Elizabeth Hospital, common hip conditions include:

  • Loose cartilage flaps caused by cartilage tears
  • Labral tears – tears on the labrum ring of the hip joint
  • Femoroacetabular impingement – abnormal bone growths on the hip joint that obstruct smooth rotation
  • Hip bursitis – an inflammation of the hip bursae, fluid-filled sacs that act as the cushion between the muscles and the bones
  • Benign tumours at the hip

Using arthroscopy to treat these injuries

Hip arthroscopy is a form of minimally invasive or keyhole surgery that can be used for both diagnostic and therapeutic purposes. An arthroscope, a thin and flexible fibre-optic scope, is inserted into the hip joint through a small incision (2cm or less) to provide the surgeon with a visual of the interior of the joint. Other surgical tools can be inserted through additional incisions for the surgeon to operate on the hip, which may include repairing tears in the cartilage or removing unwanted growths on the joint.

Studies published by the American Association of Orthopaedic Surgeons have shown that hip arthroscopy has similar success rates compared to conventional open surgery, but significantly better results over the short term. A study published in the Journal of Hip Preservation Surgery noted that hip arthroscopic patients were 85.7% more likely to report lesser hip pain and increased hip mobility after surgery compared to those who underwent conventional open surgery.

The difference between arthroscopy and conventional treatments

“Before arthroscopic surgery was available, the only option to treat hip injuries was open surgery”, Dr Dutton explains. “As there are numerous muscles surrounding the hip joint, open surgery would involve a large incision and the muscles would have to be cut.” He also adds that this was considered a major operation, requiring days of hospitalisation and significant pain and bleeding.

“With hip arthroscopy, the duration of the surgery can range from 45 – 90 minutes. In some cases, the surgery can be done as a day surgery, allowing the patient to go home the same day,” says Dr Dutton, who has 17 years of experience treating orthopaedic conditions. The nature of hip arthroscopy means that only 2 or 3 puncture wounds are required to perform the surgery, and muscles are not cut as the specialised telescopic equipment is able to access the hip joint directly.

Preparing for hip arthroscopy

Patients should understand that while hip arthroscopy comes with less risks compared to conventional methods, any surgery carries inherent risks. “Due to pressure on nerves in the hip and groin region, patients may experience numbness after the surgery,” Dr Dutton explains. While bleeding and infection risks are reduced due to the smaller cuts, there is still a small risk of infection.

“Most hip arthroscopic patients will be able to return home the same day, though some do stay overnight for observation,” Dr Dutton says. “Patients should be on crutches for around 6 weeks to prevent pressure on the hip which may injure repaired ligaments.”

After 6 weeks, patients will be able to walk independently. A study published in the Bone and Joint Journal found that 89% of patients will be able to return to sports. Dr Dutton estimates that patients can return to non-impact sports 4 months after the procedure, and impact sports after 6 months.

Finally, the choice of the surgeon is a very important one. A study published by Arthroscopy: The Journal of Arthroscopic and Related Surgery has found that surgeons who are more experienced in hip arthroscopy and have performed the procedure more than 30 times will result in better outcomes. More experienced surgeons have lower complication rates and shorter operation times.

As with all surgeries, the speed of recovery and rehabilitation should be advised by the orthopaedic specialist, who will be able to consider your specific condition.

 

Article contributed by Dr Andrew Dutton, orthopaedic surgeon at Mount Elizabeth Hospital

Reference

Cvetanovich G. L., Heyworth B. E., Murray K., Yen Y., Kocher M. S., Millis M. B.. (2015, October) Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes. Journal of Hip Preservation Surgery, 2(3): 295–302 doi: https://doi.org/10.1093/jhps/hnv037

Flores, S. E., Borak, K. R., & Zhang, A. L. (2018). Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Prospective Analysis of the Relationship Between Surgeon Experience and Patient Outcomes. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967118755048

Gwathmey, F. W., Jones, K. S., & Thomas Byrd, J. W. (2017). Revision hip arthroscopy: findings and outcomes. Journal of hip preservation surgery, 4(4), 318–323. doi:10.1093/jhps/hnx014

O'Donnell, J., Singh, P., Nall, A., Pritchard, M. (2018, February 21) THE OUTCOME OF HIP ARTHROSCOPY IN TEENAGERS – A REVIEW OF 96 CASES. Orthopaedic Proceedings, Vol. 94-B. https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.94BSUPP_XXIII.AOAoz2009-072

17.AUG.2016
img
Andrew Quoc Dutton
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Andrew Quoc Dutton is an orthopaedic surgeon practising at Mount Elizabeth Hospital, Singapore. He has subspecialty interests in arthroscopic/keyhole and sports surgery, knee and hip replacements, cartilage regeneration and stem cell therapeutics in orthopaedics.