Arthroscopic surgery may stave off hip replacement

Posted on 2 September 2020

Dr Quinton Accone, Orthopaedic Surgeon at Mediclinic Morningside explains why a simple well-timed arthroscopic intervention could be the reason athletes in their later years may not require hip replacement surgery.

Cam or pincer impingements occur when the shape of the femoral head becomes unnaturally shaped – causing pain and limiting movement. For cam impingements, the head becomes more oval and is no longer perfectly round. For pincer impingements, the bone extends over the normal rim, resulting in cartilage and labral damage. Now with the expanding scope in arthroscopic surgery, these issues can be taken care of relatively easily – and prevent further damage down the road.

Hip arthroscopies are an emerging option for surgeons who would rather perform the less invasive procedures above open surgery. Arthroscopies usually imply less downtime, faster recovery, less scarring and reduced risk of complications during and after the surgery. And according to Dr Accone, this technique is a safe and viable option for symptomatic cam-type femoroacetabular impingement (FAI) patients to relieve symptoms and improve hip function.

“Athletes in their 20s or 30s may start feeling groin pain. This groin pain could be indicative of a bone trauma rather than muscular injury, caused by repetitive hip flexion. If we can get these injuries taken care of early enough – the long term damage that would inevitably demand a hip replacement later in life can be arrested or dramatically reduced,” explains Dr Accone.

During the surgery, Dr Accone cleans out the area and repairs the damage to the labrum and articular cartilage. The FAI can be corrected by trimming the bony rim of the acetabulum and possibly also shaving down the bump on the femoral head.

“The procedure cannot save everyone. I know that my patient of 60 or 70 with severe arthritis is not going to optimally benefit from this intervention as the damage is too far gone. Their only option is a hip replacement when it becomes necessary. But in turn, should they require iliopsoas tendon release following hip replacement surgery, this can be done arthroscopically. Reducing the need for additional open surgery,” he explains.

“The area of hip arthroscopy is opening up so fast. We are discovering more and more procedures that are able to be performed arthroscopically in order to avoid more invasive surgery. This means better outcomes in the long term if the patient follows the rehabilitation prescribed,” says Dr Accone.

His multidisciplinary approach to the patient’s recovery includes rehabilitation with a physio and / or biokineticist in order for the area to be strengthened and supported before it is put under pressure again.

“Both as an interventional or diagnostic tool, I believe strongly in the offering for our patients,” he concludes. The ultimate outcome offered to the patient includes increased range of movement as well as repair of any tears in the labrum, restoring their quality of life and reducing or removing pain incurred during movement.

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