Hip Arthroscopy

By means of hip arthroscopy, major surgical procedures can be avoided and femoro-acetabular impingement (FAI), labral lesions and cartilage damage of the hip joint can be treated

Avoid major operations

Arthroscopic treatment of the hip

Arthroscopy of the hip joint has become increasingly popular in the treatment of hip disorders in recent years. This procedure has undergone significant development in terms of access and surgical techniques only in the last few decades, so that special instruments can now be used to treat diseases in and around the joint. Nevertheless, this procedure is only performed by a few orthopedists in Germany, as this type of surgery is costly and complex.

The advantage of this minimally invasive technique is the protection of the muscular structures around the hip joint, which are affected by open surgery. Likewise, there is significantly less hip and groin pain after the operation, so that rapid rehabilitation is possible.

Typical indications for arthroscopy of the hip joint concern diseases of the labrum (joint lip of the acetabulum), femoro-acetabular impingement (FAI), cartilage damage of the hip joint with cartilage procedures (cartilage cell transplantation, AMIC procedure, microfracturing, etc.) and of the structures surrounding the hip joint (tendons, bursa). The complaints are sometimes already manifested by groin pain when sitting in the car or during work, or occur during sports activity.

In addition to the clinical examination, a detailed examination also includes special imaging (X-rays, magnetic resonance imaging/MRI with contrast medium) to determine the cause of the complaints. Only in this way is it possible to plan and perform the surgical intervention precisely.

During a hip arthroscopy, both the inner part (central compartment) and the outer part of the joint (peripheral compartment) can be visualized during the operation and diseases in these areas can be treated at the same time. Likewise, structures around the hip joint can be treated (bursitis, tendon pathologies). During the operation, the hip joint is carefully dilated under anesthesia so that the joint can be carefully entered by means of X-ray control. With the help of the camera and various instruments, the diseases can then be treated.

Depending on the operation performed, an individual aftercare plan is developed for each patient, which is given to the patient and the physiotherapist providing further treatment. This ensures standardized and patient-specific aftercare regardless of the patient's place of residence.

Femoroacetabular impingement (FAI) is a mechanical disorder of the hip joint in which pain is caused by the femoral neck striking the acetabular rim. Bony abnormalities are often found at the junction of the femoral head and femoral neck (cam impingement, cam impingement) or at the acetabulum (biting forceps or pincer impingement).

Possible causes of cam impingement can be bony attachments (bump) at the head-femoral neck junction or malhealed diseases in childhood and adolescence (e.g. Perthes disease, slipped femoral head. By bending the hip, the protrusion of the femoral neck then strikes the socket and causes pain.

Causes of pincer impingement can be congenital (e.g., retroversion of the acetabulum, protrusio acetabuli) or acquired (e.g., degenerative attachments). In this case, there is usually a relatively low femoral head in the acetabulum, causing the neck of the femur to strike the acetabulum during expansive movements or simply sitting.

The labrum is a structure that seals off the acetabulum like a gasket. This keeps fluid in the hip joint to give it lubrication (similar to an engine). If there is a defect in the labrum as a result of hip impingement (FAI), it causes pain and leads to decreased lubrication of the joint. This results in higher friction, which favors the development of osteoarthritis

If there is cartilage damage in the hip joint, there are various procedures to rebuild it. However, these procedures only work if a joint space is still visible on the X-ray and the arthrosis is not too advanced.

ACI (Autologous Chondrocyte Implantation) is a procedure in which cartilage cells are removed from the patient's affected joint and then cultivated by a company. This then allows a cartilage defect to be rebuilt with the patient's own cartilage. In most cases, this procedure can be performed arthroscopically, i.e. minimally invasively using a keyhole technique. Two procedures are necessary for this technique of cartilage therapy, as in the first the cartilage cells are removed for cultivation and in the second they are reinserted.

Autologous matrix-induced chondrogenesis (AMIC) can be used to arthroscopically cover a cartilage defect with a special collagen matrix, which then leads to a build-up and sealing of the previous defect. Compared to ACT, only one operation is required for this technique.

In addition to the diseases already mentioned, there are a large number of pathologies that can also be treated arthroscopically.

  • loose joint bodies (can cause blockages and cartilage damage)
  • Chronic and active diseases of the synovium (synovitis, e.g. irritation, rheumatism)
  • benign tumors (chondromatoses, PVNS, etc.)

Hip impingement (FAI)

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Phone +49-6221-983 190
Fax +49-6221-983 199
E-Mail izo@atos.de
www.ico-atos.com
www.atos-clinics.com

International Center for Orthopedics
ATOS Hospital Heidelberg
Bismarkstr. 9-15
69115 Heidelberg / Germany

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