Why Did It Take So Long For Hip Arthroscopy?
Orthopedic sports medicine has developed and well established arthroscopic minimally invasive techniques for treating shoulder injuries, such as tears in the rotator cuff. It has likewise done the same for knee injuries, such a a torn anterior cruciate ligament.
Not so for the hip, for which arthroscopic techniques are only now coming into common practice. To understand why hip arthroscopy is only now coming into clinical practice, we sat down with Amir Jamali, MD, a two-fellowship trained orthopedic surgeon who specializes in hip and knee surgery. Click on the video to see the discussion. You can also read the transcript below.
Dr. Krongrad: We’re here with Amir Jamali, talking about hip arthroscopy. Amir, arthroscopy has been around for a long time, certainly for knee and shoulder. What took so long to bring hip into the world of arthroscopy? Why is it only coming on as a real option now?
Dr. Jamali: I think there’s basically two reasons why it’s taken so long, the hip is a very, very deep joint surrounded by some of the most powerful muscles in our body. As a result, it’s very difficult to access the hip joints. It also requires a distraction mechanism in order for you to open up the joint because the muscles are constantly closing and putting the ball back in the socket. So, in order to be able to look inside the hip joint, one has to use a traction device and those have only really been developed and fine-tuned in the last 10 or 15 years. The second reason tied into the first is that the hip is very deep and the instruments that are needed to repair structures are in the hip have to be long and are specialized. Specialized insertion tools, specialized cannulas had to be developed. Only recently have those been really fine-tuned and perfected.
Dr. Krongrad: Is hip arthroscopy ready for prime time? Is it a technique that’s sufficiently developed for properly selected patients to get full benefit from it?
Dr. Jamali: It is a technique that I’ve really been following since its inception as a mainstream procedure. When I first started doing it, there were almost no fellowships that taught arthroscopy so many of us were learning from each other and bringing some of the principles from open surgery into hip arthroscopy. Currently, it’s a very, very well-recognized procedure and many athletes from procedure to professional ranks are getting the procedure. What we don’t have is very long term results and we’re starting to see which patients are good candidates versus those better served by having hip replacement. The indications are evolving and the techniques are also improving and there’s a lot of limitations still that we have, but it’s really become a very mainstream procedure as it’s taught at many fellowships around the country right now.
Dr. Krongrad: Which are the CLEAR indications for hip arthroscopy?
Dr. Jamali: The most common indication is labrum tears. The labrum is a special cartilage that sits around the edge of the hip joint and acts like a gasket and holds the fluid within the hip and provides lubrication to the joint. That has a lot of nerve endings and when it is torn it is very painful. The same kinds of tears can progress into the central aspect of the joint and those are articulate cartilage examination region where the cartilage is essentially pulled off the bone. That’s another very common indication for hip arthroscopy. There’s also other indications such as washing out infection, taking out loose bodies. But the most common thing is to repair the soft tissue and combined with that is reshaping of the bone because bone problems can often lead to these tears in the first place. If you just repair it, you’re not taking care of the underlying problem. What you need to do is take care of the underlying problem by re-sculpting the bone so it does not cause more damage to the labrum after the surgery.
Dr. Krongrad: What might a patient expect as a consequence of having had a hip arthroscopy? What are the benefits of the procedure from the patient perspective?
Dr. Jamali: In my view, it’s one of the most underappreciated procedures we have available. Many of the patients come in, they may be almost as painful as patients who have a need for a hip replacement. They may be on crutches or a cane, they cannot sit in a chair. They’re having daily difficulty sleeping or doing activities that they enjoy with their family. Our goal after the surgery is to have them so that they have no pain in the hip and are able to do all of the activities that they want. That goal is achievable if you pick the right patients about 90-95% of the time. The key thing that we have to do as surgeons is to make sure that patients who have too much arthritis don’t get treated with hip arthroscopy because those patients would be better served with hip replacement.
Dr. Krongrad: Good, I really appreciate it. I'm sure our audience appreciates a few minutes of your time. We know it’s a new technique, we know it’s under evolution – basically like all other techniques I suppose, too. It’s wonderful to know that patients who have pain and disability in their hip joints other than oral nonsteroidal medications and such and joint replacement – there’s an intermediate option that might help them achieve a less symptomatic life. Thank you very much.
Dr. Jamali: Absolutely, my pleasure.