Nearly every joint in the body has been subjected to arthroscopy or keyhole surgical treatment, therefore keyhole surgery for the hip joint, which is the largest and most load bearing ball and socket joint in body, does not come as a surprise, although it is a relatively new phenomenon.
Groin pain in young adults is not uncommon. Groin pain that is attributable to the hip joint, in the presence of normal looking X-rays has been an enigma and has often been treated with careful neglect. There are of course other sources of referred pain that need to be excluded before attributing the groin symptoms to the hip joint.
In the recent past, femoro-acetabular impingement (FAI), also simply known as hip impingement is being increasingly recognised as a surgically treatable hip condition. It is essentially a mechanical abutment of femoral head neck over the acetabular (socket) rim in the hip joint. There is nearly always an associated tear in the labrum, which is a fibrous structure, attached to the rim of the acetabulum. Treatment is surgical removal of the torn labrum and bony prominences. The labrum can be repaired when it is torn from the attachment but still intact.
The hip joint allows a large range of movement in the frontal plane. The socket tilts forwards and sideways to allow for this. Conditions producing bumps over the head neck junction (Slipped Upper Femoral Epiphysis (SUFE), Perthe’s, Coxa Vara etc) or conditions resulting in deepened socket (Coax profunda, Protrusio, Retroversion of acetabulum, etc) produce impingement. Symptoms are enhanced in individuals requiring extreme hip movements such as rowers, jockeys, footballer’s mechanics, welders and carpet fitters. Not every one who has these abnormalities presents with symptoms and the surgical treatment is for those that present with significant symptoms that are not responsive to non surgical management.
The hip joint is a deep seated joint and surrounded by important large vessels and nerves both in the front and the back, limiting the access somewhat, even through keyhole surgery. The surgery can be open or arthroscopic. When performed effectively, arthroscopic surgery allows faster rehabilitation as it is less invasive. In the recent years, specialised equipment has made this surgery more predictable and relatively easy to perform.
The surgery requires creation of space within the joint and this is done through the application of traction. As it is necessary to cut the hip capsule to create the space to work with, rehabilitation remains painful for the initial few weeks. Traction can occasionally lead to nerve damage but this is often temporary. When performed for the right indications, the success rate is over 70-80% chance of improvement. Other conditions that can be effectively addressed though keyhole surgery are loose bodies within the hip joint and the removal of fractured fragments in fracture dislocation.
Mr Sudheer Karlakki
MBBS, Frcs(Ed), FRCS(Gl), MSc(Orth Eng)
Hip & Knee arthroscopy, replacement and revision specialist