American Hip Institute

The Procedure

Arthroscopic surgery of the hip is performed through tiny poke-hole (portal) incisions using a camera to view inside the hip joint.

A variety of instruments are used to repair torn labrum, injured cartilage and soft tissues, remove bone spurs, remove excess bone to re-shape non-spherical femoral heads or acetabular over-coverage.

The surgery is performed as an outpatient procedure and lasts approximately 90 minutes. Patients go home the same day using crutches and a brace to assure proper recovery of the hip.

Arthroscopic Labral Repair

The labrum has four essential functions to the hip:

1. Provide Stability
2. Assist in Load-bearing
3. Maintaining joint lubrication
4. Suction seal

Labral tears are one of the most frequent causes of pain in the hip. An untreated torn labrum may eventually lead to more rapid progression of osteoarthritis. Arthroscopic repair of the labrum can resolve the acute painful condition and may help prevent the progression or delay osteoarthritis.

Arthroscopic labral repair is performed using tiny plastic anchors with sutures attached. The anchors are secured into the bone, while the sutures are used to sew the labrum back to its native position on the edge of the socket. Labral repair through hip arthroscopy is a highly-technical procedure, capable of restoring the native anatomy of the hip joint. The American Hip Institute® continues to research and develop new labral repair techniques.

This procedure requires 2 weeks of crutches and a brace for postoperatively stability.

click here. to watch Dr. Domb, director of the American Hip Institute®, surgically repair a torn labrum.

 

Hip arthroscopy: labral refixation simple loop stitches:

Hip arthroscopy: acetabular labral repair – labral base refixation:

Hip arthroscopy: labral reconstruction – double bundle technique using gracilis autograft:

Arthroscopic Treatment of Impingement

Hip impingement, known as Femoro-Acetabular Impingement (FAI), is the most common cause of labral tears and progression of osteoarthritis in the hip. Impingement generally occurs due to subtle congenital or developmental abnormalities in the hip.

In order to successfully treat a painful hip, these bony abnormalities must be addressed. If the labrum is repaired alone and the mechanical boney anatomy is not corrected, the patient is at a high risk of failure and the labrum will likely re-tear.

Arthroscopic treatment of impingement involves removing excess boney abnormalities: Pincer lesion (over coverage of the socket) Cam lesion (aspherical femoral head) or Both

 

1. Femoral Neck Osteoplasty

Femoral osteoplasty is performed for Cam-type impingement, an aspherical femoral head. The Cam lesion impinges against the socket, pinching the labrum, causing labral tears and potentially damage to the articular cartilage. The osteoplasty involves precise re-shaping of the femoral head into a round sphere, so the joint may function as a ball-and-socket joint, moving free of impingement.

2. Acetabular Rim Trimming

Acetabuloplasty, or rim trimming, is performed for Pincer-type impingement. A Pincer lesion is the excess rim of the acetabulum (socket) contributing to over-coverage of the hip joint. As a result, the femoral neck (leg bone) rubs the rim of the acetabulum during motion, causing pinching of the labrum resulting in labral tears. Acetabular rim trimming involves removal of the Pincer lesion, by re-shaping the acetabulum to the native desired anatomy. This alleviates impingement of the rim and allows for an increased range of motion of the joint without impingement.

This procedure requires 2 weeks of crutches and a brace for postoperatively stability.

Hip arthroscopy: treatment of pincer and cam femoroacetabular impingement:

Femoro-acetabular impingement (FAI) – Hip arthroscopy:

Hip arthroscopy: acetabular rim trimming for a pincer lesion:

Hip arthroscopy: acetabular rim trimming with labral take down:

Hip arthroscopy: osteoplasty for cam lesion decompression:

Hip arthroscopy: Chondroplasty and osteoplasty of cam lesion:

Hip arthroscopy revision arthroscopy of a twice operated hip:

FAI and SCFE screw removal and osteoplasty – Hip arthroscopy:

Arthroscopic Microfracture

Microfracture is a procedure performed to restore injured cartilage. Tiny holes are poked in the bones, allowing stem cells to seep into the area of the cartilage defect. The stem cells can form new cartilage in the area of the defect.

This procedure has been performed on many professional athletes, such as Kobe Bryant, NBA basketball start who underwent microfracture of the knee. Today, new developments have allowed arthroscopic microfracture to be successfully performed in the hip.

This procedure requires 8 weeks of crutches and a brace for postoperative stability.

 

Hip arthroscopy: acetabular microfracture:

Hip arthroscopy: chondral damage – the wave sign:

Hip arthroscopy: full thickness acetabular delaminated cartilage flap and microfracture:

Arthroscopic Gluteus Medius Repair

Gluteus medius tears, also known as the “rotator cuff tear of the hip,” involve the tearing of the gluteus medius muscle from its attachment to the greater trochanter, commonly known as the “hip bone.” These tears may result in weakness or pain.

Many gluteus medius tears can be arthroscopically repaired by sewing the torn part of the gluteus medius tendon back to the bone using tiny suture-anchors. This procedure has a high-success rate in treating pain and may restore strength to the gluteus medius muscle.

This procedure requires 6 weeks of crutches and a brace for postoperatively stability.

 

Trans-Tendinous Approach to Gluteus Medius Repair

Gluteus Medius Double Row Repair