Hip arthroscopy effective for certain pathologies

Patients with labral tears treated arthroscopically show the best improvement.

Arthroscopic surgery can be an effective option for treating some hip pathologies, but not all patients may benefit from the procedure, according to a new study by surgeons in Ireland.

“The main benefit of hip arthroscopy in our opinion is in treatment of labral tears and removal of loose bodies from the hip joint with minimal complications,” authors Nasir Awan, FRCS, and Pauric Murray, FRCS, orthopedic surgeons in practice in Dublin, wrote in the study. “Its role in synovial-based disease is more of diagnostic rather than therapeutic value. Therefore, it is important that there is every effort made to confirm diagnosis before surgery because the key to a successful outcome lies in proper patient selection.”

Awan and Murray retrospectively reviewed their results performing hip arthroscopy in 22 consecutive patients — 17 men and five women with a mean age of 31 years. All patients had ongoing hip pain for six months or more that had not responded to nonoperative treatments. Specifically, eight patients (36%) had impaired exercise tolerance and 13 patients (59%) had mechanical symptoms. Six men (27%) who participated in contact sports also had a definite history of trauma, according to the study.

Preoperatively, surgeons obtained hip MRIs for 16 patients, including all patients with mechanical symptoms. The scans were diagnostic of labral tears in seven of 11 patients for whom such tears were confirmed arthroscopically, the authors noted. Two patients also had plain radiographic evidence of loose bodies, they added.

Surgeons performed all procedures on a standard fracture table with patients in the supine position and in traction. In all cases, the surgeons used 30° and 70° arthroscopes inserted through lateral portals 1 cm above the trochanter, according to the study.

Follow-up averaged 44 months postop, and evaluations included a 100-point questionnaire that assessed pain, mechanical symptoms, activity levels and sports participation (25 points per section). The researchers found that the overall mean score improved from 67.7 points preoperatively to 84 points at final follow-up. Pain scores also improved, from 16 points preoperatively to 20 points.

However, patients who had mechanical symptoms and definite labral pathology that was both confirmed and treated arthroscopically had the most significant improvement, the authors noted. These patients improved from a mean score of 64 points preoperatively to a mean of 90 points at final follow-up (P<.0001), according to the study.

Activity levels improved in 17 patients (77%), with the remaining five patients continuing to have some limitations. Also, 18 patients returned to their same or a similar job. The remaining four patients had continuing disability that required lifestyle changes.

The authors noted that 10 of the 14 athletes (71%) included in the study resumed normal sports participation, and all of these 10 patients had labral tears debrided arthroscopically.

No patients experienced complications, according to the study.

For more information:
Awan N, Murray P. Role of hip arthroscopy in the diagnosis and treatment of hip joint pathology. Arthroscopy. 2006;22:215-218.