Arthroscopy of the hip in young patients
Hip arthroscopy allows visualization of the articulation without opening the joint itself. Until a few years ago it was used primarily for diagnostic purposes, but its improvement has allowed its application to also intervene surgically and resolve different types of problems without having to resort to an open operation. Today it is used mainly to treat young patients.
What is hip arthroscopy in young patients?
Hip arthroscopy is a minimally invasive technique that provides visualization of the hip joint and allows surgery on it without making large incisions. The tools required to observe it and to operate on it are introduced through small incisions that leave large scars. Hip arthroscopy is indicated in young patients for the treatment of hip dysplasia by osteotomy of the femur or acetabulum, to solve problems of coxa vara or epiphysiolysis, which can lead to arthritis, to treat Alzheimer Perthes (also known as a disease of Legg-Calve-Perthes) and in case of femoral-acetabular impingement.
How does hip arthroscopy in young patients work?
The operation is performed under general or spinal-epidural anaesthesia. Prior to surgery the patient is placed in supine position on the bed or on the side and the leg to be treated is placed in traction to allow the insertion of the instruments and their movement in the hip joint. A radiograph is then performed to verify the opening of the joint. If the procedure involves the level of the neck of the femur, traction is not necessary and the hip is simply flexed to 45 degrees and rotated 30 degrees. In general practice, there are 2, 3, or (rarely) 4 incisions with width of about 1 cm through which the instruments are introduced. After an assessment of the situation we proceed with the operation itself.
What are the benefits of hip arthroscopy in young patients?
Compared with other surgical approaches hip arthroscopy reduces the time of hospitalization after surgery.
Is hip arthroscopy in young patients painful or dangerous?
Hip arthroscopy is generally well tolerated, but immediately after the operation pain may occur in the lower back, hips, buttocks and knee. There is also frequent but temporary swelling of the buttocks, the thigh or groin that tends to resolve in a few days. Other possible complications include a rare injury to the skin, muscles, nerves or blood vessels caused by traction or infections. The most common complication is a feeling of the "skin asleep" in the genitals. In general these problems are resolved in a few days or a few weeks at the most.
Which patients can undergo hip arthroscopy?
Hip arthroscopy is contraindicated in case of osteoarthritis, advanced osteonecrosis of the femoral head associated with the collapse of the epiphysis, in the presence of a joint anchilotica or coxa protruded serious. Age may also represent a relative contraindication if the patient is too old for the procedure.
Immediately after the operation pain may occur in the lower back, buttocks, hip and knee, but painkillers are usually sufficient in relieving the pain. The recovery time is about two months, during which you must follow a program of physical therapy to recover both lost mobility hip muscle tone. It may also involve the use of crutches, worn for about two to four weeks depending on the case. 3 to 6 months recovery time is necessary for patients who wish to continue practicing a sport at a competitive level.
The patient must follow the rules of preparation required for surgical anaesthesia.