Hip arthroscopy: relieving hip pain without fuss

Many people would spend weeks, sometimes even months, hobbling between general practitioners and physiotherapists in an attempt to alleviate a niggling pain in the hip. They may be young and might have been born with a slight deformity, professional sportspeople who are hampered from delivering peak performances or simply and Average Joe who has hurt himself slightly while playing golf or chasing his children on a beach.

“The point is that they don't have to suffer the pain, or keep shuttling between their doctor and physiotherapist to alleviate the pain on a short term basis. Technology now allows for a highly specialised surgical technique called hip arthroscopy, which could well help to fix the problem in the hip joint with minimal collateral damage and a quick recovery time,” says Dr Cakic, an orthopaedic surgeon at the Centre for Sports Medicine and Orthopaedics at Netcare Rosebank Hospital.

Could you be a candidate for the procedure?

Dr Cakic has performed a hip arthroscopy on more than 400 patients to date. He says that, if you feel a stabbing or pinching hip pain only in certain positions, such as when getting out of a car or playing sports (especially pivot or rotation type movements), you might be an ideal candidate for a hip arthroscopy.

The pain may not be excruciating but it does result in a 5% to 15% loss of function, sometimes even more depending on the type of activity, which affects quality of life and diminishes athletic performance for the otherwise active and healthy individual.

“An X-ray or CAT scan of the hip often does not reveal any problem within the joint. This is because the damage in the early stages is to the soft tissue in the hip joint and therefore undetectable by these imaging procedures. The patient, who has initially gone to their GP with the problem, will therefore have difficulty identifying and treating it,” Dr Cakic explains.

A hip arthroscopy is based on the same principles as knee or shoulder arthroscopy. As hip arthroscopy is quite a new medical technological procedure, it is not widely known that it could alleviate hip pain caused by conditions such as, amongst others, labral tears, loose bodies of cartilage within the joint, snapping hip syndrome, cartilage damage or even the very early stages of arthritis.

Why undergo a hip arthroscopy?

Dr Cakic says that, while traditional hip surgery can also repair any damage and make the pain go away, hip arthroscopies are much less invasive. This means smaller incisions, a simpler and faster recovery process and returning to normal activities and sports much quicker.

“What is more, by undergoing this procedure it may be possible to prevent the hip damage from worsening, postpone the need for a hip replacement or even eliminate that need entirely,” says Dr Cakic.

What does the procedure entail?

“The first step in identifying the cause of these conditions is to make an appointment with an orthopaedic surgeon that specialises in hip arthroscopies. The surgeon will do a thorough clinical examination and from there decide what other type of further investigation may be needed, such as an MRI scan done in the correct position,” says Dr Cakic. “We have to consult quite intensively with the patient, do some blood (pathology) tests and consider the individual's clinical circumstances.”

On the operation table three or four small incisions will be made so that a small optical cable with a camera can help the surgeon to visualise or ‘see' the joint area properly. While the camera is inserted through one incision, the surgeon will use another incision to access the joint area with small instruments to fix whatever needs fixing, and yet another to pump water into the area (this helps with the visualisation process).

Patients are hospitalised for only one day. After the procedure it usually takes more or less six weeks for recovery. This is achieved through a rehabilitation process, starting the day after the operation, which would involve light exercise that would gradually get heavier. You would need to see the surgeon again at around three months and six months for follow-up assessments. Full return to sporting activities will depend on the extent of the repair done.

Dr Cakic warns: “This is not a quick, easy fix that will see you playing games of squash a mere six weeks after the operation. That may only happen after three months, as you have to allow nature to participate in the healing process.”

He concludes: “However, the good news about hip arthroscopy is that those patients who had to modify their lifestyles in order to accommodate hip pain might no longer have to do so. It is a highly specialised yet simple procedure that is an effective treatment option for many hip conditions that may have gone previously undiagnosed.”