Arthroscopic total hip replacement

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Information from the American Academy of Orthopedic Surgeons

An arthroscope is a telescope about 5-6 millimeters in diameter, that can look into joints.

This optical system consists of lenses, light source, fiber optic cable, and a video monitor.

Arthroscopy of the hip joint is somewhat difficult in that the hip joint lies deep. Nerves and arteries run in close proximity to the joint and the joint capsule is strong.

There is very room for movement of the arthroscope within the joint. The progress of the arthroscope into the hip joint is guided by fluoroscopy.

The operation is done under general anesthesia with the patient prone or on their side. Traction is applied to the leg. Most complications from arthroscopy are actually caused by traction which is quite forceful. Traction is necessary to "open" the hip joint to provide space for the arthroscope.

Indications are:

(1) Diagnostic to evaluate the damage in the lip of the hip joint capsule ("labral tears"), and damage to the cartilage not demonstrated on X-ray or MRI.

(2) Extraction of loose bodies and cartilage debris in patients with mild osteoarthritis of the hip joint.

More recently, arthroscopic hip procedures have been used to mend labral tears and to fix impingement problems.

The mini-incision hip replacement procedure uses specialized instruments and surgical techniques to implant the same hip implants used in standard hip replacement. This is not exactly an arthroscopic procedure but it is much less invasive than the standard hip replacement technique. The new technique allows the implant to be inserted through a 2.5- to 3.5-inch incision, rather than the standard 10- to 12-inch incision. Benefits of the technique include:

• Smaller scar
• Shorter hospital stay
• Faster rehabilitation.

There is usually a quicker return to work and other daily activities.

Mini-Incision hip replacement is an option for most patients who are candidates for standard hip replacement. Factors that may rule it out include prior hip replacement on the same hip, obesity, a recent history of deep vein thrombosis (DVT), and other unstable medical conditions.

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