Ask the Expert: Dr. Struan Coleman, Orthopedic Surgeon, Answers Your Questions on Hip Arthroscopy
Q1. Will a hip arthroscopy fix a labral tear or will it eventually re-tear?
Hip arthroscopy is a minimally invasive surgical procedure used to treat a number of conditions of the hip joint, including labral tears, loose bodies, cartilage damage and bony impingement. A torn labrum can usually be repaired with suture anchors during hip arthroscopy. Once the labrum has been repaired and all bony impingement has been corrected there is a very small chance that the labrum will re-tear. However, if the labrum is repaired without removing the bony impingement there is a high likelihood that the labrum will tear again.
Q2. In someone with FAI (femoro-acetabular impingement) (both cam and pincer), what is typically the maximum degree of femoral retroversion for which arthroscopic surgery can still be effective, rather than needing a femoral osteotomy to correct the retroversion?
Prior to recommending a patient for hip arthroscopy, many patients will likely undergo a CT scan of the hip to look for dysplasia. Dysplasia is defined as an abnormal relationship between the femoral head (ball) and the acetabulum (socket). Typically, dysplasia manifests as an under-coverage of the femoral head, either caused by a shallow acetabulum or a version abnormality in which the acetabulum is anteverted or retroverted. Dysplasia is a developmental condition and puts the patient with dysplasia at a higher risk of developing hip arthritis at a younger age. When the hip dysplasia is severe, the patient is of an appropriate age and the cartilage in the hip is preserved, we may recommend an osteotomy (cutting of the bone) in order to correct the mismatch between the acetabulum and the femoral head. The goal of an osteotomy is to prevent arthritis of the joint from occurring. Hip arthroscopy, prior to or following an osteotomy, is peformed specifically to treat a torn labrum or to remove excess bone.
Q3. What are some complications that can occur with a hip arthroscopy?
There have been a number of complications reported following hip arthroscopy, including superficial wound infection, nerve injury and hip dislocation. Fortunately these complications are extremely rare.
Q4. How can a hip arthroscopy treat arthritis in the hips?
Hip arthroscopy is not indicated in the setting of advanced arthritis of the hip joint. One of the potential outcomes following hip arthroscopy, although rare, is that the patient goes on to develop arthritis requiring a hip replacement. This arthritis is not a result of the arthroscopy, but rather occurs despite the arthroscopy and implies poor patient selection by the surgeon. However, arthroscopy of the hip can be used to treat patients with focal cartilage loss in the joint. During arthroscopy, a microfracture procedure is used on focal cartilage loss to stimulate the growth of a cartilage-like membrane. Focal cartilage loss can occur in the setting of both cam and pincer impingement of the hip or as a result of a hip dislocation.
Q5. How long are the recovery and rehabilitation time following a hip arthroscopy for a labral tear?
In our practice, patients are on crutches with protected weight bearing for 1 to 2 weeks following hip arthroscopy. Patients undergoing a microfracture procedure are on crutches for a longer period, sometimes as long as 6 weeks. Patients can return to work and to normal activities of daily living quite quickly following arthroscopy of the hip; however, time to return to sports is usually 3 to 6 months and can in some cases take up to a full year. A detailed rehabilitation program under the supervision of an experienced PT or ATC is critical to a favorable outcome following hip arthroscopy. The rehabilitation program can last up to 3 months.
Dr. Struan Coleman is an orthopedic surgeon and specializes in sports medicine at Hospital for Special Surgery. He is currently the head team physician for the New York Mets.