The hip head and socket form the central anatomic structures of the hip joint. The central area of the hip joint with the hip head and socket can be best assessed and simultaneously treated at the same time when extended. Degenerative damage to the joint surfaces, inflammations of the inner liner of the joints, and freely floating pieces of cartilage can be diagnosed. The neck of the thigh and the edge of the socket (peripheral part of the joint) can be viewed well even when not extended. A joint lip (labrum) is found on the edge of the joint; it is very important for the best functioning of the joint.
CLINIC CARE AND DIAGNOSIS
Exact case history and examination supplemented by x-rays and MRI images are indispensable for a precise diagnosis. Assessment of the gait profile and examination of active and passive movement of the hip joint are necessary. Pain on bending, adduction, and internal rotation suggests a pathology on the edge of the head (damage to the labrum) or bony impingements on the neck of the thigh. X-ray diagnosis as the basic examination tool shows us traumatic and degenerative damage to the head, neck, and socket. The MRI images, which are performed with a contrast medium, give us reliable hints regarding damage to the cartilage and to defects in the labrum.
Arthroscopy of the hip joint is a recommended treatment for patients with blocks, constrictions, and unexplained pain on movement.
The operation occurs under total anesthesia and requires an inpatient stay of several days. An optical device and instruments are inserted into the joint using several small cuts in the skin. The head of the hip must be drawn 1-2 cm out of the socket on an extension table in order to get a good view. During the operation, it is possible to assess and treat damage to the joint (smoothing out of the cartilage, drilling through and polishing away zones with problems). Tears in the edge of the socket (damage to the labrum) are smoothed out or refixed in place. Removal of the impingements on the neck of the thigh or on the edge of the socket improves the joint movement and does away with painful constrictions.
After the operation, the patient may exert 10-20 kg of weight on the hip joint. As a rule, crutches are necessary for 2 weeks. Treatment of the cartilage (boring, polishing) requires a longer period of no weight-bearing. Physical therapy and movement exercises on the treadmill start on the very day of the operation.