Hip Impingement Surgery via Hip Arthroscopy
Hip Impingement surgery aims to relieve the pain and impingement caused by the abnormally shaped head. In femoroacetabular impingement (FAI) the abnormally shaped CAM lesion impacts against the labrum of the acetabulum causing damage. This can cause the labrum to detach. Labral injuries of the hip can cause significant pain. Often the pain is directed at the front of the groin region. Current evidence suggests that FAI is the precursor of arthritis.
Dr Chien-Wen Liew believes that FAI surgery should be performed using a combined arthroscopic and open approach. 90% of impingement syndromes affect the anterior aspect of the hip joint, making the direct anterior approach a sensible option. The direct anterior approach is a specific intermuscular approach to the hip joint, that utilises an internervous and inter muscular plane. This means that muscles and nerves are respected and injury is minimised. In some cases, the hip joint does not require an open approach. This is the case when the labrum is damaged beyond repair. When this occurs, a hip arthroscopy is used to remove the damaged piece of labrum. Often, Dr Liew will perform both the arthroscopic and then open approaches if the labrum can be fixed. Performing an open approach for fixation of the labrum takes less time in general, than performing it arthroscopically, and as such, can reduce the risks associated with long arthroscopic repairs. (The evidence for open vs arthroscopic approaches is still evolving).
During FAI surgery, the capsule of the hip is opened in a special way, making repair successful after surgery is complete. During hip arthroscopy the capsule is often removed in parts, to allow access during the arthroscopy. The main types of surgery for femoroacetabular impingement is via arthroscopic or open means. Arthroscopic utilises small portals and specialised cameras and equipment that allow access to the hip joint (“keyhole” surgery). When extensive work is required, performing a hip arthroscopy may cause injury due to pressure to the small nerves supplying the perineal region when the hip is under traction for an extended period of time (>2hrs). If only a labral debridement is required, then arthroscopy is suitable. There is a risk of avascular necrosis of the hip during excessive, prolonged traction, or during an open approach which requires the femoral head to be fully dislocated. This is minimised in open approaches as traction is only applied for a very short time, to access any central defects, and the hip is not fully dislocated.
The downside of the direct anterior approach for hip impingement syndromes is when there is pathology at the back of the hip joint. This is not easily accessible from the Direct Anterior Approach. Dr Chien-Wen Liew will not perform this type of approach if your pathology exists in the posterior (back) region. This will be evident on a specific pre-operative MRI which will show where the pathology exists.
Hip impingement surgery is a specialised field, and requires attention to detail, and a meticulous approach to investigation and operative technique in order to minimise complications, and maximise long term benefits. It is a common cause of groin pain in athletes, all of who wish to return to their pre-injury activities. In sedentary individuals, hip impingement syndromes often do not cause significant difficulties, but is currently thought to be a contributor to early development of hip osteoarthritis.
For more information, please contact the rooms of Dr Chien-Wen Liew on (08) 7099 0188
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