What is hip arthroscopy?
Arthroscopy is a technical term for keyhole surgery of any joint. Keyhole surgeries in other joints such as knee, shoulder, wrist and elbow have been well established. The hip joint has long been regarded as a difficult joint to arthroscope as it is a ball and socket joint and, very deeply seated. In 1931, a researcher called Burman from New York, even said, "It is manifestly impossible to insert a straight needle between the head of the femur (ball of hip joint) and the acetabulum (hip socket)."

Why hip arthroscopy?
Until recently any approach to the hip joint by surgeons, involved open surgery of the hip joint. Open surgery means a large incision, joint dislocation and a hospital stay of 7 days or longer, exposing the patient to potential risks such as infection, deep vein thrombosis (clots in deep veins), avascular necrosis (subsequent death of the ball of hip joint), major nerve or vessel injury and muscle weakness. Open surgery of the hip joint in young adults, therefore, may expose the joint to the ravages of arthritis in later years.  Arthroscopy of the hip joint, therefore, appears to be an attractive option as similar procedure in other joints has proved to be very successful.

What are the recent advances?
Although a fairly new concept in India, globally hip arthroscopy has taken arthroscopic surgery almost by storm. Arthroscopy of the hip joint has led to a greater understanding of the nature of adolescent and adult hip pathologies, and, offers comprehensive access to an evolving series of conditions that affect the hip joint, many of which were previously unrecognised and, thus, left untreated.

Hip arthroscopy helps to treat some conditions such as early arthritis, loose bodies, ligament and cartilage (labrum) tears, synovitis (inflammation of the joint capsule), infection, fractures and, sometimes, tumours.

What does the surgery involve?
Hip arthroscopy is usually a day case, or overnight stay, operation and takes approximately 45 minutes to perform. Patients are advised to remain non-weight bearing for four days after surgery to avoid damage to the soft articular cartilage (gristle) as the fluid is passed through the hip joint under high pressure to clear any debris during the procedure. It is also important to avoid high impact activities in the first six weeks.

Who are the potential gainers?
The troublesome young hip in most cases. The indications are increasingly becoming vast. Historically, athletes with hip injuries were simply resigned to living within the constraints of their symptoms, being diagnosed with an ill-defined chronic groin injury, often prematurely ending their competitive careers. Recognising the presence of these problems early has led to a better understanding of the mechanisms of hip injury. The procedure also helps to diagnose and treat conditions in young adult hips such as very early arthritis, small loose bodies within the hip joint. These problems are otherwise impossible to diagnose with conventional investigating procedures.

What is the downside then?
Hip Arthroscopy is not widely available as it requires much specialised equipments and takes a long time to learn. Very few surgeons perform this procedure. The procedure carries, with it, a complication rate of approximately 5% and, it is possible that some patients may not get benefit out of this surgery. However, the overall results and benefits of this procedure, performed by well-trained surgeons, far outweigh the risks.

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