HIP ARTHROSCOPY
Hip joint problems have been among the fields of interest of orthopedics for many years. hip in old years
Treatment with prosthesis method when the cartilage of the joint is well worn and the quality of life of the person deteriorates
was being made. As a result of the researches, some small and treatable deformities are seen in many patients.
cause irreversible cartilage damage and over the years, usually in older people, hip
It was observed that coxarthrosis (hip calcification) required prosthesis. causing hip calcification
These deformities are now called Femoro-acetabular Impingement syndrome.
Hip-sparing surgery came to the fore after it was seen that deformities were treatable and hip calcification was prevented when treated. The procedure, which was previously performed as open surgery, is now performed with the closed method hip arthroscopy as a result of technical advances and experiences.
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What is FEMORO ACETABULAR IMPRESSION SYNDROME?
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The hip joint is one of the largest joints of our body, and consists of the head of the femur (thigh bone) sitting in a perfect harmony with its socket (acetabulum) as if it were sitting on the bed of a ball. As we mentioned at the beginning of our article, it is the situation caused by deformities in the anatomy of the hip joint. So what are these deformities?
Deeper than normal hip socket (acetabulum)
Femur (thigh bone) hump formation in the femoral neck by disrupting the head-neck harmony
Bone growths on the hip socket edges causing compression.
These disorders, briefly mentioned above, disrupt the load distribution in the hip joint, cause the rupture of the LABRUM, which is an important structure in protecting the health of the joint, which surrounds the joint like a gasket at the edge of the acetabulum, and causes destruction in the cartilages in its immediate vicinity and initiates calcification in the hip.
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What are the signs of femoro-acetabular impingement?
The most common finding of FAS is pain. Patients usually cannot show pain in the hip completely. The pain may be in the groin, buttocks, or in front of the knee in a way that spreads to the front of the thigh. In general, the intensity increases during squatting and sitting. In some patients, there may be complaints of noise or snagging in the joint. Joint movements may be restricted. It can be severe and at an earlier age, especially in people who play sports.
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How is the diagnosis of femoro-acetabular impingement made?
Being aware of the presence of such a disease is important for diagnosis. When patients present to the outpatient clinic with long-lasting symptoms, the physician should consider this disease if the symptoms do not regress despite the diagnosis of synovitis, arthritis, herniated disc, muscle pain.
Diagnosis is made mainly by suspecting this disease and by performing a disease-specific examination and detecting findings in X-rays (which used to be considered normal). In some patients, even if no pathology is detected on direct radiographs, the diagnosis can be made with MRI and 3D tomography.
Treatment
Most patients can be treated with hip arthroscopy, which is a closed type of surgery. With hip arthroscopy, the detected pathologies are treated by entering 2 or 3 incisions of 1 cm in the hip joint.
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Advantages of hip arthroscopy:
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The biggest advantage is the short recovery time and return to work/sports time. In open surgery, it was necessary to reach the hip joint with a 20 cm incision, open the muscles, remove the hip joint - put it back in place, and then suture the cut structures.
Hip arthroscopy, on the other hand, can only be operated with the help of 2-3 or 4 incisions of 1 cm each, without displacing the hip joint. The muscles and other soft tissues around the hip are not damaged and the hip joint is not dislocated.
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Disadvantages of hip arthroscopy :
There are also disadvantages to such an elite treatment. The biggest disadvantage is that it is technically difficult compared to other arthroscopies, requires special training and experience, and requires more special devices for hip arthroscopy than ordinary arthroscopies, so it is applied by a limited number of ORTOPEDISTs both in our country and in the world.
Complications:
Complications occur rarely compared to open surgery. One of them is the possibility of transition to open surgery due to insufficient visual angle during the operation, deterioration of the surgical instruments, etc. With the developments in recent years, this risk has decreased a lot. There may be temporary numbness due to stretching in some nerves after surgery. Most importantly, especially in elderly patients, 10% of the patients may require hip replacement surgery if the complaints do not go away despite the treatment.
HOW IS HIP ARTHROSCOPY DONE.
First of all, for this procedure, the hip joint distance should be stretched and opened by approximately 1 cm with a method called traction, and a fluoroscopy (mobile x-ray device) is required for imaging during the surgery. A very thin pen inserted into the joint with scopy at appropriate positions Intra-articular imaging is visualized with a camera up to the tip. It is inflated with intra-articular serum with a machine called an arthropump to create constant pressure in the joint. Then, the existing pathology is repaired by entering the joint with very special shavers, radiofrequency devices, etc., with 1 cm incisions around the joint.
Only femoro acetabular impingement syndrome is not treated with hip arthroscopy surgery.
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Labrum tear repair.
Cartilage damage surgery and stem cell application at the same time.
Washing, drainage, debridement in hip joint infections.
For diagnosis and treatment in inguinal webs of unknown cause.
Cleaning of intra-articular cartilage fragments and synovium in case of synovitis.
Repair of tendon tears around the hip
Many ailments such as hip arthroscopy are treated with the method.
