[Arthroscopy of the hip joint]. / Artroskopie kycelního kloubu.

ABSTRACT

PURPOSE OF THE STUDY Arthroscopic examination of joints has recently gained wide application. Due to hip joint shape and a difficult approach to it, hip arthroscopy has long remained outside the attention and abilities of arthroscopists. The authors present their first experience with operative hip arthroscopy that offers new options for the treatment of intra-articular pathology of the hip joint. MATERIAL: In the years 2001-2003, 24 hip arthroscopies were performed. The following pathological conditions were diagnosed and treated loose bodies, chondral lesions of the femoral head and acetabulum, ruptures of the labrum acetabuli and ligamentum teres, impingement syndrome of the labrum acetabuli, and coxitis. No post-operative neurologic symptoms or vascular complications were observed. METHODS: All procedures were carried out on patients in a supine position, with the treated joint in traction. A standard 30 degrees device and common instruments for arthroscopic surgery were used. The instruments were inserted in the articular fissure with the use of an X-ray intensifier. Movement in the hip joint during surgery is very limited due to traction, joint shape and the length of working canals. After traction is released, it is possible to examine also the intra-articular part of the femoral neck. RESULTS: The pre-operative complaints (clunking, painful joint) were relieved up to 4 to 6 weeks after surgery in 23 patients. In one patient primarily diagnosed with coxitis, infection was not eradicated after lavage and debridement and, because inflammation deeply affected the femoral head, the hip was eventually treated by Girdlestone arthroplasty. The results were evaluated clinically and on the basis of the Merle d'Aubigne and Postel questionnaire assessing pain and walking abilities by both the patients and the surgeon. All 24 patients reported poor or average conditions before surgery and, after surgery, 23 experienced improvement to a very good or average condition. One patient's state failed to improve and was evaluated as poor both before and after surgery. DISCUSSION: Hip arthroscopy is a minimal invasive technique which allows us to diagnose and, at the same time, treat intra-articular pathology in a gentle manner. In arthroscopic surgery, correct diagnosis (X-ray, CT and MRI), correct patient's position, their body mass (obesity), selection of appropriate approaches to the joint, surgeon's experience and potentials of arthroscopic instruments all play an important role. We assume that, with increasing experience, the number of patients as well as the scope of diagnosed and treated pathological conditions of the hip joint will grow. The outcomes of operative arthroscopy were very good (improvement in 23 of 24 patients) and it is probable that this technique can slow down or prevent early wear-and-tear hip arthritis. CONCLUSIONS: In our country, operative arthroscopy of the hip is only at its beginning. However, it can be assumed that, similarly to other large joints, it will soon become a widely used, indispensable diagnostic and therapeutic method.