[Arthroscopically-assisted procedures on the hip joint].

PURPOSE OF THE STUDY: Since 2000 arthroscopically-assisted surgery on hip joints has become more widely used. The technique is relatively demanding and should be used only after arthroscopic procedures on other large joints are mastered to perfection. A thorough study on cadaverous specimens should be a prerequisite for adopting it as a routine method. The aim of this study was to evaluate indications for hip arthroscopy as, from the year 2006, this was gradually introduced and more widely used at our department.

MATERIAL AND METHODS: Forty-two hip joints were assessed out of the 83 hips which had been treated by arthroscopic surgery before the date of evaluation and which had been followed up for at least 2 years. The patient group evaluated consisted of 25 men and 17 women, with an average age of 40.3 years and a range of 21 to 65 years. Patients with a follow-up shorter than 2 years and those subsequently undergoing total hip arthroplasty were not evaluated. Indications for arthroscopic surgery included the presence of intra-articular bodies, labro-cartilaginous lesions and impingement syndromes. Neurovascular disorder affecting the limb and a higher degree of osteoporosis were considered contraindications. The outcome of surgery and its indications were evaluated on the basis of the questionnaire which recorded the patient's objective findings and subjective feelings at 3 and 6 months and then at 1 and 2 years after surgery.

RESULTS: The average VAS score was 7.83 points before surgery, and 3.87 points at 3 months and 2.01 points at 2 years after surgery. Nearly all patients (98%) reported their willingness to undergo the surgery again. The complications included transient hyperesthesia in the perineal region completely resolved within 4 weeks of surgery in three cases and subcutaneous extravasation after extensive capsulotomy in one patient. It subsided within 48 hours without compartment syndrome development.

DISCUSSION: A good view allowing for comprehensive exploration of the central as well as peripheral compartments enables us to treat all pathologies, which are manageable by arthroscopic intervention, in one procedure. Patient recovery is faster and the risk of intra- and post-operative complications is lower that in open surgery. The avoidance of extensive capsulotomy and the possibility of leaving the femoral head in place with only minimum distractions and without injury to the ligamentum capitis are the most important advantages of this method. Complications were found in 8.4% of the cases, which is in agreement with the literature data. The method can be applied in both the diagnosis and therapy of chronic conditions such as femoroacetabular impingement, as well as in the treatment of post-traumatic conditions ranging from traumatic labral lesions to the correction of incongruence of articular surfaces in acetabular fractures.

CONCLUSIONS: Arthroscopically-assisted surgery enables us to achieve very good results, but requires appropriate, high-standard facilities and a well-mastered operative technique. It should be adopted as the method of choice for young adults still free of arthritic changes including hip impingement syndrome. Similarly to arthroscopic procedures on shoulders and knees, it is associated with low risk factors, and rapid recovery allows the patient to return soon to normal daily activities.