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  • www.sportordination.at

Hip

Hip arthroscopy

 

Whilst arthroscopy of the knee or shoulder joint is already used as a matter of course, arthroscopy of the hips or the hip joint is still carried out rather rarely. Hip arthroscopy has the advantage here that it is a minimally-invasive procedure, only three small incisions are required – whilst the alternative consists of opening up the entire joint (a bone has to be sawed for this, the hip dislocated and the bone rescrewed after the operation), which obviously involves much greater pain after the operation.
The following problems with the hips can be solved well with arthroscopy:

Femoroacetabular impingement (FAI):
Runners as well as football players often suffer from hip pain of unknown origin, which radiates from the groin backwards towards the buttocks. Internal rotation with a flexed hip is often also very painful in these cases. The most common cause of these symptoms is femoroacetabular impingement (FAI). The cause of FAI is an incongruence in the acetabulum and femoral head. This causes pronounced friction forces, which lead to injury to the labrum and/or to rapidly progressing cartilage damage.

The incongruence can have two causes:

1) a lack of spherical shape of the femoral head (i.e. the head of the femur is not as round as it should be). This is known as cam impingement (see image)
2) a pronounced covering of the acetabulum (this can be congenital, or may develop over decades). This is called pincer impingement (see image)
Most patients (86%), however, suffer from a mixed type, in which cam impingement is predominant in young athletes, because the head of the femur is positioned in a suboptimal position genetically.
Diagnosis: Clinical examination, MRI, possibly also CT examination
Treatment: In the case of cam impingement, the transition of the head to neck of the femur can be appropriately shaped arthroscopically, during which it must be ensured that adequate bone is removed.
For pincer impingement, projecting sections of the acetabulum must be removed. This can be difficult to carry out arthroscopically.

Loose bodies:
Caused either as a result of cartilage injury or due to degenerative changes in the joint, these pieces that are freely floating around the joint can often become wedged and cause severe pain as a result. The joint bodies can usually be recovered very easily using hip arthroscopy.

Injuries of the labrum:
The labrum is a cartilaginous strengthening ring in the acetabulum and can either be torn as a result of injuries (frequently in athletes involved in ball sports) and/or due to overstraining (such as in the case of femoroacetabular impingement). Depending on the extent of the injury, the labrum can either be smoothed or in some cases even completely reattached.

Coxa saltans (snapping hip):
With this, most young female athletes complain of an uncomfortable and painful snapping phenomenon in the hip. The cause is often a prominent osseous protuberance slightly beneath the femoral head (over which the iliopsoas tendon runs), which can either be milled off or a groove can be made in the affected muscle arthroscopically. An additional cause for a snapping hip can be injuries to the labrum.

Cartilage damage:
Cartilage damage to the hip caused by injuries can be treated well by means of arthroscopy. See also cartilage.


Hip prosthesis

 

In the case of pronounced wear and tear of the cartilage (arthrosis) and corresponding clinical symptoms (in particular pain when standing up, walking, or even pain at night), implantation of a hip prosthesis is unavoidable.
Appropriate investigation is carried out by means of clinical examination, X-ray imaging, and MRI where necessary.
Implantation of hip prostheses is carried out in a much more gentle manner than it was ten years ago. Minimally-invasive techniques are now available, with which muscle damage can be largely minimised.

 

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.