Hip arthroscopy is a minimally invasive diagnostic operation, which is the most informative method of studying this anatomical formation. It is indicated for traumatic injuries of the structural elements of the hip joint, chronic progressive diseases, prone to frequent relapse and resistant to therapy. The limited use of the technique in clinical practice is explained by the complexity of the procedure due to the need for preliminary distraction of the joint (stretching of bones performed to expand the joint gap).
Indications and contraindications
Hip arthroscopy of the joint is prescribed with insufficient information content of non-invasive diagnostic techniques at the final stage of examination of the patient. As indications, the suspicion of damage to ligaments, cartilage and bone elements of the joint, the presence of foreign bodies (including bone fragments) in its cavity, progressive degenerative–dystrophic lesions of various genesis (post-traumatic, caused by hip dysplasia, etc.), necrosis of the femoral head, the presence of adhesions in the joint cavity is considered.
The method is not used for ankylosis, since the fusion of articular surfaces excludes the technical possibility of examining the joint cavity. Arthroscopy is contraindicated in general acute infections, local purulent processes in the joint and surrounding tissues, severe obesity, severe traumatic injuries of the pelvic bones and soft tissues of the pelvic region, decompensated renal, cardiovascular and respiratory insufficiency.
Methodology of conducting
Inspection of the joint cavity is possible only after stretching the limb, providing an increase in the size of the joint gap. Modern traumatology uses a number of distraction systems created specifically for hip arthroscopy. The method of registration is chosen taking into account the age of the patient, the nature of the pathology, etc. It is possible to pre-impose a distraction device or stretching on an orthopedic table with an anti-lock.
The operation is performed under endotracheal anesthesia in the position of the patient lying on his back or on his side. Before the start of diagnostic hip arthroscopy, an X-ray examination with external metal markers is performed, according to the results of which landmarks are applied to the patient’s skin (contours of the anterior superior iliac spine, the large trochanter and the upper edge of the pubic symphysis). The area of the neurovascular bundle is also marked (determined by the pulsation of the femoral artery) and the points through which access to the joint will be carried out.
With the help of a long injection needle, a saline solution is injected into the joint with the addition of adrenaline for additional expansion of the joint gap. Then, point incisions are made for the introduction of an arthroscope. Usually, the cavity is examined from three approaches: anterior, anterolateral and posterolateral. The technique allows you to audit all parts of the joint, to study in detail all the important anatomical formations. At the end of the examination, the traumatologist removes the fluid and applies adhesive or ordinary skin sutures to the skin in the incision area. Wounds are closed with aseptic dressings.
In the first days after surgery, doctors prescribe painkillers and anti-inflammatory drugs to patients. In parallel with this, the medical staff carefully cares for the postoperative wound and monitors the adequate motor activity of the patient. It is important that in the first 7-10 days a person loads the operated limb by 50%, and his gait is symmetrical.
From the second to the third week, the patient is prescribed water procedures and a set of physical exercises. After another 2-3 weeks. manual therapy is added to the treatment, and physical activity is enhanced. At 8-12 weeks, a person usually studies independently. As a rule, he performs exercises aimed at strengthening the hip joint. At the end of this period, he returns to his usual level of motor activity.
Judging by the reviews of patients, hip arthroscopy is a painless and low-traumatic operation. With a successful outcome of surgery and the absence of complications, most patients return to their usual lifestyle.
In recent years, hip arthroscopy has become increasingly popular. However, along with the increase in the number of arthroscopic interventions, the total number of complications also increases. Fortunately, they are mostly transient and appear in only 0.5-6.4% of cases. But sometimes patients have severe consequences that reduce their ability to work in the future.
- Distraction neurapraxia. Occurs due to prolonged traction effects on the hip joint, which can last several hours. As a result, the patient develops ischemia and damage to the femoral or sciatic nerve. Pathology is a violation of nerve conduction while maintaining their continuity.
- Iatrogenic damage to cartilage or acetabulum. Articular structures can be damaged during penetration into the joint cavity or when performing intra-articular manipulations. More often, the front or upper part of the lip suffers.
- Irrigation fluid leakage. The pathology is characterized by the penetration of fluid from the synovial cavity into the anatomical spaces located near the hip joint. Quite often, saline gets into the abdominal cavity. There are cases when leakage led to paralysis of the femoral nerve.
- Infections. Arthroscopy is a long-term operation involving the introduction of instruments and foreign materials into the joint cavity. Naturally, during manipulations, doctors risk bringing an infection.
- Deep vein thrombosis of the lower extremities. Thromboembolic complications develop in 2.8-3.7% of patients. Fortunately, they respond well to treatment and do not leave behind serious problems. In rare cases, patients may experience PE.
- Breakdown of tools. The hip joint is surrounded by a wide layer of soft tissues, which creates difficulties in obtaining surgical access to it. This, together with the pronounced curvature of the articular surfaces, significantly increases the risk of damage to arthroscopic instruments.