Arthroscopy is a minimally-invasive surgical approach. Rather than a large incision, we’re able to access the joint through small poke holes. We use a camera and instruments to access the hip.
For hip impingement, which is something that we commonly treat, we address some of the abnormal shape to the hip joint. With an abnormal shape to the hip joint, you can have what’s called cam impingement, where there is extra bone along the femur, and this can impact up against the rim of the acetabulum or socket. This can injure the soft tissue structures between it. In addition, you can also have over-coverage, where the socket is overlying the ball part of the hip, and that can also cause soft tissue disruption. There are others where you can also have sub-spine impingement. All of these can be addressed with our arthroscopic approach.
We’re not cutting the hip. What we’re first doing is actually addressing the soft tissue structures within. We access the hip through the poke holes and using the camera and the instruments, we’re able to stitch back the labrum, back to where it belongs.
The labrum is a soft tissue structure that surrounds the hip.That’s important for stability and function of the hip. It’s important for us to be able to repair that, that we’re able to access that joint. This is different from the way it was done many years ago, where you actually had to dislocate the hip, a big open procedure with a long recovery. This is one where we’re able to get people back a lot faster in terms of what they want to do.
In terms of fixing the labrum, we also want to address why it was actually injured in the first place. A lot of times it has to do with hip impingement. A lot of times we use a bur and reshape the bone to hopefully prevent this from happening again. A bur is a device that can cut away bone. It oscillates or it spins, and from that we can actually trim the bone down. We’re shaving the bone.
Hip arthroscopy is the best procedure in terms of getting you back to more of a functional level. For someone who does not have arthritis, a hip replacement would not make much sense. With hip arthroscopy, if we’re able to repair and treat the issues at hand, we feel that we’re able to make a big difference in terms of the natural history of the hip to hopefully prevent a hip replacement in the future too.
Hip replacement surgery on a young person can be limiting in terms of what activities you can go back to. It’s almost like tread on a tire, if you are active on a hip replacement, you can wear it out. In addition, they don’t last forever. If you’re very young, you could have numerous surgeries down the road and the outcomes for hip replacement numerous times over are not quite as good as they are the first time. With hip arthroscopy, we’re able to use the same parts and save the patient’s tissue a lot of times.
The data has shown that it does last probably 20-25 years, and that is using the instruments that we had many years ago.
If you’re a young person, you don’t want to have a new hip because then in your 50s, 60s, 70's, you have to have another hip again. Also, you don’t necessarily go back to the activities that you want to. Running on a hip replacement is not necessarily recommended. Playing soccer, basketball, all the activities that you potentially want to get back to are not things that a hip replacement really can allow you to do. That’s why hip arthroscopy, especially for those who don’t have arthritis, and who are young, active and otherwise have good healthy tissue, we feel we’re able to get those people back to what they want to do.
You’re home the same day. We give patients an anesthetic at the time of surgery, and the procedure itself typically takes about an hour and a half to two hours. They go home soon thereafter. Most people are not on pain medication for any extensive period of time.
You’re able to put weight on your hip right away. I let you get on the stationary bike the day of, and we send you home with a motion machine. The idea is to get you moving almost immediately.
That varies for some. The big issue is really kind of getting the muscle function back. You spend probably the first six weeks working on getting your motion. After we get your motion, then we’re really working on getting that muscle strength back. For some, getting back to the gym, two and a half, three months in is a very good expectation. Getting back to high-level activities, that can range sometimes between four to six months. For some, it can come much quicker.
My training was specific for this. This is an area of sports medicine that only a few surgeons actually practice in San Diego, and really throughout the country itself. With that being said, this is the fastest-growing segment of sports medicine and for that reason, it has been a very worthwhile venture for myself and for Scripps in terms of being able to bring that to San Diego.
It is based on the examination, on the physical findings, as well as the objective findings with your imaging. That can tell us whether or not you have good, healthy tissue. It is also based upon what you want to get back to. Those are the patients that we’re looking for in terms of being able to return them back to that healthy state. Typically it is a younger patient, typically those without arthritis. Those are the ones that we feel that we’re going to make the biggest difference in terms of getting them back to what they want do.
If it’s been bothering you enough and it’s keeping you from what you want to do, you should probably be seen by your doctor. If you’re having long-standing hip problems, that usually is a good telltale sign that there is something going on within the hip.
It varies. I usually say let pain be your guide. If it’s not responding to anti-inflammatories and you feel that it’s keeping you from what you want to do, if you’re not able to perform to the level that you want, it is then time to see your doctor and potentially consider hip arthroscopy, based on a thorough evaluation.
For a select group of patients, especially for the older group, we do feel that we’re able to make a big difference. If you don’t have much arthritis, a lot of times, based upon what we know from the data, this can make a big difference. In addition, we also treat abductor tears, that are actually outside the hip, which we can also do endoscopically as well.
One of the big risks with hip procedure is that typically we had you on a bed with a post, to pull the leg with slight distraction in order to safely access the hip. Sometimes groin numbness was one of the complications related to this. We don’t have that anymore. We now have this new bed that has been released here in the last year. We have that available here at Scripps. We don’t have that complication because of the postless distractor, where there is no post between the hips that can lead to that groin numbness after surgery.
Outcomes have been limited for those patients who have advanced arthritis. For people who have advanced arthritis, the cartilage being degenerative at that point, hip arthroscopy has not been able to make as big of an impact. A lot of times, a hip replacement is probably better suited for them if they do have advanced arthritis. Arthritis is the biggest key in terms of what the cartilage looks like.
Sometimes an injury is really severe. In certain cases, the labrum, which is that soft tissue structure that surrounds the hip, can sometimes be very damaged, and it’s sometimes not even salvageable. There are certain situations where we’re not actually able to repair it based upon the tissue quality and integrity. We’re able to replace it with what we call a reconstruction. Those are specific, specific rare instances where the injury is so bad that we’re able to replace that tissue as well.
What would contribute to a severe injury is for example if you’ve had these symptoms for a long time. That labrum, which could have been torn, could become more and more degenerative.
Watch the San Diego Health video on hip arthroscopy with host Susan Taylor and guest Brian Rebolledo, MD, orthopedic surgeon.