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         hip arthroscopy   

 

 

 




Arthroskopie

In contrast to the rapid development of minimally invasive surgery on the knee and shoulder joints, arthroscopy has developed only very slowly on the hip joint. The reasons for this are many. Many symptoms were not recognized and therefore remained untreated. The development of special instruments for hip joint arthroscopy and the improved quality of nuclear magnetic resonance tomography has helped us. Indications for an arthroscopic hip operation are found in patients with chronic hip joint pain caused by lesions of the labrum-capsule complex and impingements on the neck of the thigh. Other indications are damage to the cartilage on the head and socket, beginning arthroses, and freely floating pieces of cartilage.



ANATOMY

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.



INDICATIONS

Arthroscopy of the hip joint is a recommended treatment for patients with blocks, constrictions, and unexplained pain on movement.



OPERATION

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.



FOLLOW-UP TREATMENT

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.

 

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right hip joint with femoral head and ligaments (anterior aspect)


Arthroscopy of the right hip Standard access points for optical devices and instruments


Arthroscopic view of the head of the hip (above) and hip socket (below)


Right hip joint after removal of bony impingements on the neck of the thigh bone

 
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