The April issue of Orthopedics Today reviewed the advances in hip arthroscopy and these advances have helped many people. Hip arthroscopy is performed under anesthesia so the hip can be pulled slightly apart. That allows the surgeons to insert instruments and tiny video cameras through small incisions to repair internal damage. Hip arthroscopy is less invasive than open surgery so patients recover faster and with less pain. New techniques are allowing surgeons to tackle more complex problems without needing to open the hip.
However, there are limits to hip arthroscopy. The review in Orthopedics Today provides additional support that hip arthroscopy should usually be avoided as the main treatment for hip problems caused by dysplasia. For a more complete explanation you can read the IHDI education statement about the role of hip arthroscopy in patients with hip dysplasia.
When the socket is poorly developed in hip dysplasia, there is excessive pressure on the soft edge of the socket. The soft edge is called the labrum, and tears in the labrum occur from dysplasia because the socket is too shallow and the edges are under a lot of pressure even during normal activities. When the hip socket is normal, hip arthroscopy may be an excellent way to repair a torn labrum caused by an injury as long as the injury doesn’t happen again. The normal socket continues to support the soft edge after the repair has healed. However, a shallow socket from hip dysplasia cannot adequately support the repair so the tear is likely to occur again and again unless the bone is restored to a more normal shape. That’s why PAO surgery is usually the best answer for hip preservation when the socket is shallow. If the dysplasia is very mild, it may be possible to provide some pain relief by arthroscopic repair of a torn labrum, but more advanced dysplasia is likely to break down again.
Sometimes the torn labrum needs to be removed because it is severely damaged, but that only makes the socket shallower and can lead to rapid deterioration in cases of hip dysplasia. Removal of the labrum may be OK in patients who have a nice deep socket, but it’s important to make sure the socket is normal before removing a damaged labrum. Sometimes surgeons have difficulty evaluating the shape of the socket unless they are experienced in PAO surgery. Patients who have removal of the labrum in the presence of hip dysplasia may develop more pain and rapid deterioration of their hip condition if arthroscopy is the only procedure performed to try to treat their hip dysplasia.