Arthroscopy (also known as a scope) is using a small camera to look inside of a joint and to do work within it. It's an emerging aspect of sports medicine and is probably the fastest growing part of sports medicine.
Parts of an arthroscope and preparing the joint
The arthroscope’s main feature is the camera. When a physician is doing surgery, we are using the camera on the arthroscope to get a view inside the joint. We watch the view on a screen and perform the surgery almost like it’s a video game.
The lens on the arthroscope allows us to change the view like a periscope on a submarine, looking up and around the corner.
The light cord shines a light through the camera so we can see inside the joint.
Preparing the joint
When doing an arthroscopy, there needs to be enough room in the joint for the camera and the instruments to safely move around. We fill the joint with saline fluid to swell the joint enough for us to do our work.
Top 3 Hip Scope Google Searches in Virginia
I wanted to address your top questions about hip arthroscopy, as found through Google search.
How successful is hip arthroscopy?
Success depends on how you define it. Some people have a goal to be without pain, to be able to sit, stand, take walks with their dog and their family, and do everyday activities. For those patients, the success rate is around 85-90%, or very successful.
After a big surgery like a hip arthroscopy, returning to playing sports like you did before is more difficult than getting back to everyday life. Around 70% of people go back to play like they played before the injury.
How long is the recovery after hip arthroscopy?
Most people will be on crutches for a few weeks after a hip arthroscopy. They may or may not wear a brace, depending on their specific circumstances. Around eight to ten weeks after the surgery, most patients are able to walk around and do daily activities. Higher impact activities like running generally start to happen around three months after surgery, and people who play competitive sports return to sport usually after six to eight months. It may take some patients ten to twelve months to get the full benefits, or even longer in some cases depending on their individual circumstances.
What complications can occur after hip arthroscopy?
Risk is always there anytime you do a surgery, but hip scopes are extremely safe and the complication rate is very low, around six percent.
Infection is a risk in any surgery, so we take every precaution necessary to prevent it. Blood clots are a risk, so we usually have you on a blood thinner to prevent them. Some people can have nerve irritation after surgery, which for most patients who have it feels like decreased feeling on the side of your thigh. The nerve irritation is usually gone after a few weeks. Finally, unfortunately, some people will have a retear of the labrum.
I think of recovery in five stages.
Phase 1: Week 0-2
In the first phase, you’re in physical therapy about once a week, working on gradually restoring your hip motion, getting your hip to move again, and remembering how to fire the muscles around your hip.
Phase 2: Week 2-6
In the second phase, the goal is for you to walk more normally. While you’ll have crutches in phase one, in phase two you’ll stop using first one crutch and then both crutches. During the phase, your physical therapist is watching you like a hawk to make sure you’re walking properly and are not developing a limp or bad habits.
Phase 3: Week 6-12
In the third phase, you start strengthening and your physical therapy starts to feel like a workout. You’ll do leg presses and knee extensions, core work, squats, and so on.
Phase 4: Week 13-16
In the fourth phase, we’ll gradually introduce running with a good form with the therapist watching you. The goal of the previous weeks was to get your muscles strong enough to protect your hip for when you add impacts. Additional activities will also be introduced depending on your goals. For instance, if you play soccer, this phase is when you would start introducing light drills such as dribbling drills or kicking the ball back and forth.
Phase 5: Week 17-Month 6
The fifth phase is Choose Your Own Adventure: the details depend on what your goals are. If you’re going to play competitive sports, we’ll start talking about testing your strength to see if you’re ready to play sports again. If you pass those tests, we start looking at getting you back into low-impact, low-contact practice for your sport. Return to sport is a process, not a moment in time. Even when you’re “cleared for sport”, you’re not starting by playing a whole game. You’ve had a serious injury, so we want to make sure that you fully recover before you go all the way back.
Reasons to Do a Hip Scope
The main reasons to do a hip scope are to fix a labrum and/or to deal with hip impingement.
Fixing the labrum of the hip
If the hip is a ball and socket joint, the joint is surrounded by a kind of suction cup called the labrum. That suction cup is meant to hold the hip joint kind of solid, and when it gets torn you can develop microinstability where the hip doesn’t say as stable as it should. Microinstability feels like pain to most people. It usually seems like pain in the groin and can be mistaken for other conditions.
During the surgery, I pass stitches up and around the labrum and anchor it back into the bone using suture anchors, which are tiny plastic screws. They go into drill holes on the socket bone, or acetabulum, and hold the labrum in place until it can heal.
Our stitches are man-made, and the body has to heal itself. Our goal is to put the labrum back into place and try to stimulate healing at that site.
Treating hip impingement
Some people will have an extra bit of bone next to the ball part of the hip joint that makes their ball look more like a square peg in a round socket, so it tends to hit the socket instead of moving smoothly. The labrum is between the bone and it can be torn or injured, as can the cartilage of the joint itself. It’s common to have impingement and a labral tear go together.
We can smooth out the bone so that there is no longer a bump, preventing the bones from rubbing against each other.
The Hip Capsule
Every joint in your body has a capsule around it, like Saran Wrap that holds the joint in place. The hip joint has the strongest capsule because the hip is one of the strongest joints in the body. When we perform surgery, we need to open up the hip capsule intentionally because it’s so thick and we need to get below it to do our work. Over time, we’ve learned that it is very important to make the effort to suture the capsule back together. Patients do better, with better outcomes, better return to sport, and better pain control if you close the capsule over the hip joint.
Frequently asked questions
Are you able to have an arthroscopic procedure if you’ve had a fracture that results in permanent hardware such as rods or screws?
It depends on the situation and the specific type of metal implants you may have. In some cases it is possible and in other cases it is not. I would recommend talking with the doctor who performed the surgery to see what type of implant you have and see if an arthroscopic procedure could be done.
Can people who are waiting to get a hip replacement for arthritis get a hip arthroscopy in the meantime?
A hip arthroscopy can be helpful for someone who is not ready for a hip replacement if they meet the proper criteria. However, if a patient is ready for a hip replacement, a hip arthroscopy wouldn’t necessarily stop you from having it.
If someone has arthritis, the cartilage between bones has worn away. Someone with grade three arthritis has no cartilage left and a bone-on-bone joint, a common time for a hip replacement. Someone who has grade two or three arthritis will tend to not do well with hip arthroscopy, because even if we fix the labrum or smooth out the cartilage we cannot replace cartilage. Not having the cartilage causes pain.
If someone has a little bit of arthritis, grade one, or no arthritis, grade zero, they will likely see more benefit from a hip arthroscopy. Some studies have shown that people with grade one hip arthritis can do well with a scope but take longer to recover than someone without arthritis.
Do labral tears always need surgery or can they also heal on their own?
The majority of people with labral tears do not need to get surgery, only people who have tried other treatments that don’t work. Most people will be able to strengthen the muscles around the hip joint and allow the muscles to act as a stabilizer.
Is there an age restriction for this surgery?
There is no strict age restriction, but people over the age of 60 tend to have arthritis in their hip. Hip arthroscopies cannot fix pain caused by hip arthritis, so the procedure is less common for people over 60. The typical age range is between ages 16 and 50, but the surgery itself is based on your personal circumstances and your personal goals.
What can a patient do ahead of surgery to improve results and recovery?
Prehab, or rehabilitation exercises before surgery, help work the same muscle groups you’ll be using after surgery and get them into better shape. For a hip arthroscopy, those muscles include your gluteus maximum, medius and minimus. Working your gluteus maximum with exercises like squats is one portion of the prehab but not all of it. Abduction activities, like sitting and opening up your legs side to side or lying on your side and lifting your leg up to the ceiling, are also important. Additionally, getting your core musculature optimized by using exercises like planks or sit-ups is very important.
Which diagnostics are performed to diagnose tears versus arthritis?
An MRI combined with an x-ray is the usual diagnostic standard. An x-ray shows the bone and the bone alignment, but can’t show cartilage or the labrum. It shows how much space there is in the joint, which can be used as a proxy to determine arthritis. An MRI will show the cartilage and the labrum inside a joint better, so using both methods is helpful.