Hip arthroscopy is a minimally invasive surgery that can be done for therapeutic or diagnostic purposes. The doctor gains access to the joint cavity and performs the necessary manipulations under visual control. To do this, he just needs to make 3-5 small incisions in the thigh area.
Marking before surgery.
The advantages of arthroscopy include low morbidity and relatively quick rehabilitation . After arthroscopic intervention, a person does not have a huge postoperative wound. Thanks to this, his ability to work is restored in just 8-12 weeks. Patients do not need 5-6 months of outpatient rehabilitation (as after endoprosthetics or osteosynthesis).
A little history! The first mentions of arthroscopic surgical interventions can be found in the works of MS Burmam. He described them back in 1931. The first atlas of arthroscopic surgery of large joints was published by M. Watanabe in 1957. After this, interest in the technique subsided and resumed only in the 80-90s. last century.
Indications for hip arthroscopy
The most common indication for arthroscopic intervention is acetabular labral tear . This structure is located along the edge of the acetabulum and additionally fixes the head of the femur. Injuries, dislocations and subluxations of the hip joint usually lead to disruption of its integrity. The pathology is characterized by painful sensations in the groin area.
Rupture of the acetabular labrum.
A labral tear can be suspected when pain in the hip joint appears suddenly and persists for more than 4 weeks. In this case, the patient must undergo magnetic resonance imaging (MRI). Once the diagnosis is confirmed, the person requires arthroscopic surgery.
Quite often, arthroscopy is performed on patients with impingement syndrome. The pathology is characterized by collision of hip joint structures during movements. The reason for this may be individual structural features of the joint (aspherical shape of the femoral head, excessive coverage of the acetabulum by the articular labrum, etc.). Since impingement syndrome leads to the development of deforming osteoarthritis, patients with this pathology simply need to be operated on.
Other diseases requiring arthroscopic treatment:
- transchondral cartilage fractures;
- avaccular necrosis of the femoral head;
- pathological changes in the synovial membrane;
- rupture of the round ligament of the femur;
- instability of the hip joint;
- septic arthritis;
- the presence of foreign bodies in the synovial cavity.
Curious! Most often, the patients of endoscopic surgeons are young athletes who engage in figure skating, acrobatics, artistic or rhythmic gymnastics.
Acetabular labral tears
The socket of the hip joint is formed by the pelvic bone and is called the acetabulum. Along the edge of the cavity is the acetabulum , a fibrocartilaginous formation. It increases the depth of the socket by 30%, increasing the contact area of the femoral head and acetabulum and thus promoting joint stability. But the main function of the acetabular labrum is the synthesis of synovial (articular) fluid, which evenly lubricates the articular cartilage of the femoral head and nourishes it. By creating a suction effect, the acetabular lip strengthens the hip joint. In addition, the acetabular labrum contains nerves that determine the position of the femoral head in space. You can read more about the anatomy of the hip joint in the general article on the causes of pain in the hip joint.
The structure of the hip joint: in order to show the acetabular labrum, the head of the femur in the picture is “dislocated” from the joint
Transverse section of the hip joint: the acetabular labrum, bordering the acetabulum, increases the area of contact with the head of the femur
The acetabular labrum, being a soft tissue structure, can rupture. Most often, tears of the acetabular labrum occur in athletes. Ruptures can be traumatic, i.e. occurring against the background of relatively severe trauma, or dystrophic (degenerative), which occur against the background of chronic trauma. Dystrophic tears are common in ballet, as well as in sports that require strong hip flexion (football, mountaineering) or frequent hip rotation (golf, figure skating, martial arts).
A torn acetabular labrum causes mechanical obstacles to movement in the hip joint, which is manifested by pain in the groin or buttock, with an arc enveloping the hip joint from the outside. The pain is often accompanied by clicking or a sensation of obstruction in the hip joint. It is worth noting that not all pain or clicking in the hip joint is a sign of a labral tear: many other injuries and diseases can cause pain in the hip joint.
The abnormal structure of the hip joint (dysplasia, femoroacetabular impingement syndrome) predisposes to dystrophic ruptures. For example, with hip dysplasia, the acetabular labrum is hypertrophied (increased in size) and prone to tears. Femoral-acetabular impingement syndrome is characterized by persistent trauma to the acetabular labrum, which leads to its degeneration and ultimately to rupture.
Acetabular labral tears are similar to knee meniscus tears, but are much less common in comparison. The relative rarity of acetabular labrum ruptures is determined by the fact that many doctors do not even know about the existence of such a condition. However, this is not surprising, since tears of the acetabular labrum occur mainly in athletes and only a doctor who treats athletes can know about such an injury. On the other hand, it is possible that tears of the acetabular labrum are very common in ordinary people, and progress in diagnostics, in particular, the spread of magnetic resonance imaging, will make it possible to identify this problem not only in athletes.
There are two main types of labral tear: flap and marginal avulsion. In both the first and second cases, the damaged area ceases to perform its function, the dangling fragment of the acetabulum interferes with movements, is pinched in the joint, which, as we have already noted, is manifested by pain and possible clicking noises during movements. The insidiousness of ruptures of the acetabular labrum is that the dangling fragment also damages the adjacent cartilage covering the head of the femur, which leads to its chondromalacia (gradual thinning and abrasion). It is possible that chondromalacia, in turn, can cause a more serious condition - arthrosis of the hip joint (coxarthrosis), but scientists do not yet have a common point of view on this matter. Since the acetabulum borders the acetabulum along its circumference (with the exception of the area at the bottom of the acetabulum), tears can occur in different places. There are tears in the anterior, superior and posterior parts of the acetabular labrum.
The main types of acetabular labral tears. On the left - a normal acetabular labrum, in the center - a flap gap, on the right - a tear along the edge like a “watering can handle”
Detachment of the acetabular lip along the edge like a “watering can handle”
A loose fragment of the acetabular labrum damages the adjacent cartilage covering the head of the femur, leading to chondromalacia and arthrosis of the hip joint.
Diagnosis
Pain from a labral tear is usually felt in the groin or upper thigh. Often, patients, showing a sore spot, clasp the thigh with their thumb and forefinger in front and outside of the hip joint so that these two fingers form the contours of the letter C. Pain can also be felt behind the hip joint, in the gluteal region. It is possible that anterior tears tend to present with pain in front of the joint (in the groin), and posterior tears tend to present with pain behind the joint (in the gluteal region).
Pain from a labral tear is often accompanied by mechanical symptoms: clicking or a sensation of obstruction in the joint. As with other diseases of the hip joint, pain can radiate down the leg, usually along the front leg, less often along the inner surface of the thigh to the knee.
The pain can be of different nature and range from mild, dull, provoked by physical activity and passing during rest, to severe and constant, seriously limiting daily activities. Few patients have a significant limp or require crutches, but they try to avoid certain positions and movements (mainly hip flexion, abduction, and rotation) that cause pain.
Traumatic labrum rupture is primarily caused by an external force applied to a fully extended and externally rotated hip. Often the patient can point to a specific injury, such as a fall or twisted ankle, that preceded the onset of pain. The diagnosis of a labral tear often goes unrecognized, and people try to be treated for a “groin sprain” that actually turns out to be a labral tear.
Less commonly, the disease develops gradually, due to chronic trauma, which leads to degeneration of the acetabular lip and ultimately to its rupture. In this case, the patient cannot definitely indicate the time of onset of pain, cannot indicate the fact of injury.
An examination by a doctor can usually distinguish a labral tear from the internal type of snapping hip syndrome. The patient is placed on his back and his sore leg is bent, bringing the thigh into a position of flexion, adduction and internal rotation; the pain of this movement indicates a tear of the acetabular labrum.
There is also a special test that helps determine a labral tear. It was suggested by Joseph McCarthy. The patient is placed on his back with his legs bent to fix the pelvis, after which the affected leg is extended, rotating the thigh outward, and then the same movement is repeated, rotating the thigh inward. When a painful click appears, the test is considered positive and indicates a tear of the acetabular labrum. A tear in the acetabular labrum may also be indicated by pain in the groin when lifting a straight leg against the doctor’s resistance, but this is too nonspecific a sign that can also appear with other diseases of the hip joint.
To confirm or exclude a complex diagnosis of acetabular labral tear, additional research methods are required. A traditional plain radiograph of the pelvis and hip joints (to compare the hip joint of the diseased and healthy leg) and a radiograph of the affected hip joint in the position of hip flexion and abduction (in the so-called frog position) with a labral tear are normal. They may show hip dysplasia, which may contribute to a labral tear.
With old ruptures, there may be changes in the bone - subchondral cysts, which indicate chondromalacia or detachment of the acetabular lip from the articular cartilage. These cysts are most often located in the upper outer part of the acetabulum.
Femoral-acetabular impingement syndrome (impingement syndrome) is one of the anomalies of the hip joint, accompanied by dystrophy and tears of the acetabular labrum. Its most characteristic radiological sign is the so-called pistol grip sign, that is, flattening of the anterosuperior part of the femoral neck, which is why it appears abnormally convex and, together with the femoral head, resembles a pistol grip. Bone cysts may be visible in this convex part of the neck. A Mayo Clinic study found that 87% of patients with acetabular labral tears had at least one abnormality on radiographs. This study included all patients with acetabular labral tears seen in the clinic over a 6-year period and was not limited to sports-related injuries.
Computed tomography and bone scintigraphy are usually uninformative.
Perhaps the most accurate research method to detect a tear in the acetabular labrum is magnetic resonance imaging . However, unfortunately, magnetic resonance imaging also gives a high percentage of false negative results (i.e. the tomogram turns out to be normal when the labral tear is actually There is). Therefore, in any case, the importance of a doctor’s examination should not be diminished, and only those findings on magnetic resonance imaging that correlate with clinical signs are significant, i.e. those features that the doctor reveals during examination.
Magnetic resonance imaging showing a tear of the acetabular labrum in its upper part (the red arrow indicates the fragmented nature of the acetabular labrum, its irregular shape). On this tomogram, the acetabular labrum shows dark colored areas.
For differential diagnosis of pain in the hip joint, a local anesthetic (Novocaine, Libocaine, etc.) can be injected into the joint under fluoroscopy control: temporary pain relief after this procedure indicates intra-articular pathology.
An accurate diagnosis can be made through arthroscopy - an operation in which an arthroscope (video camera) is inserted into the joint cavity through an incision, or rather a puncture, about one centimeter long, which allows you to examine the joint from the inside and finally make sure of the exact diagnosis.
The main methods for diagnosing intra-articular pathology of the hip joint remain questioning and examination by a doctor - in comparison with arthroscopy (as a diagnostic standard), they allow a correct diagnosis to be made in 98% of cases. By comparison, magnetic resonance imaging produces false negatives in 42% of cases and false positives in 10% of cases. However, such high numbers of errors in magnetic resonance imaging may be due to incorrect interpretation of images by radiology doctors, who are not always familiar with acetabular labral tears. Pain relief in response to the injection of a local anesthetic into the hip joint indicates intra-articular pathology with 90% reliability, however, this test is not specific to acetabular labral tears, but covers all diseases of the hip joint, which once again emphasizes the importance of a competent examination by a doctor.
Treatment
Conservative treatment. A rupture of the acetabular labrum usually cannot be treated conservatively - it has virtually no blood supply in people over 20 years of age and therefore the ruptures do not heal on their own. Therapeutic exercise can relieve muscle spasms and correct gait, and non-steroidal anti-inflammatory drugs reduce inflammation and, to a certain extent, alleviate the symptoms of pain, but neither physical therapy nor non-steroidal anti-inflammatory drugs can eliminate the source of inflammation and completely relieve the patient of symptoms. However, the geometry of the fracture is also important. If the gap is small, then it will not cause a cascade of intra-articular disorders (choronromalacia and, then, arthrosis of the hip joint). With small ruptures, self-adaptation of the joint is possible. Sometimes athletes with constant severe pain in the hip joint due to tears of the acetabular labrum, indicating inflammation of the joint, are injected into the joint with glucocorticoids (hydrocortisone, diprospan), however, as a rule, this gives only a temporary result. If the tear of the acetabular labrum is large enough, then complete recovery is possible only through surgery - arthroscopy of the hip joint.
Surgery. Unfortunately, surgical treatment of acetabular labral tears produces less predictable results than treatment of knee meniscus tears. Hip arthroscopy allows the doctor to see the labral tear and thereby confirm the diagnosis. The goal of the operation is to remove or reattach the torn portion of the lip that is loose in the joint cavity and causing symptoms, while preserving the remaining portion of the intact lip as best as possible. During arthroscopy, you can also examine other structures that can cause pain and clicking in the joint (articular cartilage of the acetabulum and femoral head, ligament of the femoral head, and joint capsule). During the operation, the torn part of the acetabular labrum is removed, thereby eliminating the mechanical cause of the pain. In some rare cases where there is extensive marginal acetabular labral avulsion, arthroscopic suture of the avulsed acetabular labrum may be performed. This operation is performed on the same principle as the Bankart operation for habitual dislocation of the shoulder joint.
Arthroscopy of the hip joint: a video camera (arthroscope) is inserted into the joint cavity through a 1-centimeter incision, which allows you to examine the joint from the inside and see all the damage. A tear of the acetabular labrum is shown; a fragment of the labrum is pinched between the head of the femur and the acetabulum
Arthroscopic suture of the torn acetabular labrum is carried out according to the same principle as the Bankart operation for habitual dislocation of the shoulder joint
Complications
There is no reliable information in the published scientific literature regarding the consequences of acetabular labral tears, and the risk of developing severe osteoarthritis of the hip joint after them is unknown. However, a detrimental effect of a labral tear on the cartilage covering the femoral head cannot be ruled out. For this reason, surgical treatment is recommended only for athletes whose pain and decreased mobility in the hip joint are so severe that they interfere with successful sports activities. The mere presence of an acetabular labral tear on magnetic resonance imaging should not be an indication for surgery.
The complications of hip arthroscopy are the same as those of any operation performed under general anesthesia. In addition, there may be iatrogenic damage to the acetabular labrum or articular cartilage, breakage of endoscopic instruments during surgery, traction injury to the nerves of the leg (as the leg must be extended during arthroscopy), or direct damage to the sciatic nerve or lateral femoral cutaneous nerve during placement of trocars (devices in which a video camera and instruments are inserted into the joint cavity).
Forecast
The results of arthroscopic treatment of single traumatic ruptures of the acetabular labrum are very good: 80-90% of patients experience a complete recovery, after which they can return to professional sports. Even after a successful operation, clicking in the joint (especially in certain positions) may remain, which should be warned about in advance.
With dystrophic tears caused by frequent repetition of movements traumatic for the joint, the prognosis for returning to sports is quite poor, especially if chondromalacia (softening of the cartilage, its abrasion) is detected during arthroscopy.
For some time after arthroscopy (from 2 days to 2 weeks), the patient is prohibited from leaning on the operated leg. In the first 2-6 weeks after surgery, physical therapy is carried out aimed at developing the joint, and after 6-12 weeks it is usually possible to resume training.
The literature provides very little information regarding the prognosis of arthroscopic operations in patients with bone anomalies of the hip joint. In cases of severe hip dysplasia, acetabular retroversion, or femoroacetabular impingement syndrome, symptoms should be expected to persist. Surgical treatments for these anomalies have been described, including supracetabular osteotomy and femoral neck osteoplasty, which requires trochanteric osteotomy and dislocation of the femur from the hip joint during surgery. The same dislocation of the femur allows access to and repair of complex tears of the trochanteric labrum like a watering can handle.
Prevention
The best way to prevent it is to avoid movements that cause the femoral neck to strike the acetabular labrum. This, of course, is impossible in those sports that involve swinging movements of the legs or strong rotation of the hip, in particular in golf, figure skating, martial arts, dance sports and artistic or rhythmic gymnastics.
Acetabular labral tears often occur in poorly trained athletes during leg swing movements, for example, in high school dancers performing a step jump, or in athletes who press heavy loads with their legs without a full warm-up. The correct organization of the training process can prevent such gaps.
Many female athletes experience acetabular dysplasia, accompanied by increased mobility of the hip joint. This helps gymnasts and ballerinas in their activities, but it also reduces hip stability and predisposes to labral tears. Tears of the acetabular labrum are often associated with osteoarthritis of the hip joint, especially developing against the background of hip dysplasia, and femoroacetabular impingement syndrome.
Materials used when writing this article:
Byrd JW, Jones KS: Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004;32(7):1668.
O'Leary JA et al: The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy 2001;17(2):181:
Siebenrock KAet al: Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop 2004;Feb(418):54.
Wenger DE et al: Acetabular labral tears rarely occur in the absence of bone abnormalities. Clin Orthop 2004;Sep(426):145.
| The author of the article is Candidate of Medical Sciences Sereda Andrey Petrovich |
Features of operations
The operation is usually performed on an orthopedic table under regional anesthesia. The patient can be placed on his back or side. To relax the joint ligaments, the limb is flexed and slightly rotated outward. In order to expand the joint space and eliminate myoretraction, doctors perform preliminary traction on the limb for 15-20 minutes. All this allows the surgeon to freely perform the necessary manipulations in the future.
First of all, the doctor performs an audit of the hip joint. In case of a rupture of the acetabular labrum, he re-fixes it to the attachment site; in case of impingement syndrome, he performs resection of osteophytes or other necessary manipulations. If a patient is diagnosed with gross defects of cartilage tissue, he undergoes abrasive chondroplasty.
Curious! In recent years, doctors have begun to use arthroscopy to treat deforming osteoarthritis. During surgery, they inject mesenchymal stem cells into the synovial cavity or plant artificially grown cartilage tissue. Note that such treatment is effective only in the initial stages of the disease.
Treatment of impingement syndrome
When carrying out diagnostic measures, it is necessary not only to establish the presence of hip impingement syndrome, but also to determine its type and cause of development. It is also necessary to evaluate other components of the joint to detect pathological changes in them.
After determining the type of hip impingement syndrome and the severity of the situation, patients are prescribed either conservative or surgical treatment. However, it is impossible to accurately predict what effect conservative treatment of the disease will have. When choosing a surgical method to solve the problem, excellent results are achieved by surgery performed when the joint space is narrowed to no more than half of normal values, i.e., when its width is more than 2 mm. The prognosis for surgery is somewhat worse when the patient consults an orthopedist at the stage when there are already pronounced signs of secondary arthritis.
In general, the prognosis for hip impingement syndrome is significantly better in young patients who begin treatment in the shortest possible time after the onset of signs of femoroacetabular conflict.
Conservative treatment
When choosing a non-surgical treatment tactic, a set of therapeutic measures is mandatory. It includes:
- refusal to perform movements that cause pain (complete immobilization of the joint is not indicated, as it is fraught with deterioration in its functioning, although it can be prescribed for a short time in the presence of a pronounced inflammatory process);
- Exercise therapy, thanks to which an increase in the possible amplitude of movements of the hip joint is achieved, and also strengthens the muscles;
- physiotherapeutic procedures, in particular ultrasound therapy, electrophoresis, magnetic therapy and laser therapy;
- drug treatment, which consists of prescribing NSAIDs for oral administration and local application, and in case of severe pain, intra-articular blockades are performed using corticosteroids.
Additionally, intra-articular injections of hyaluronic acid and plasma lifting can be prescribed, which helps to activate the natural processes of cartilage tissue regeneration. This is important for chronic damage to the acetabular labrum.
Surgery for impingement syndrome
Surgical intervention may be prescribed immediately after diagnosis of impingement syndrome or after attempts to cope with the situation using conservative methods have failed after 3-4 months of treatment. The main indication for its implementation is a decrease in the quality of life and the occurrence of difficulties when performing household duties, while working or playing sports.
Today, operations for impingement syndrome are performed arthroscopically, that is, by introducing special endoscopic equipment through pinpoint punctures of soft tissue. This ensures a good cosmetic effect and allows you to eliminate all obstacles to the normal functioning of the joint. The main task of the surgeon is to remove osteophytes and thus remove the obstacle to the free sliding of the femoral head in the acetabulum.
However, in rare cases it is necessary to resort to standard open surgery. To perform this, an 8-10 cm long incision is made. The surgeon cuts off the greater trochanter of the femur and dislocates the hip. After this, the formations that interfere with the normal functioning of the joint and the plastic of the altered structures are removed.
It is important not to be afraid of surgery for impingement syndrome. The consequences of refusing it or delaying it are more dire, since the existing mechanical conflict in the joint will progress and ultimately lead to deforming arthrosis of the hip joint or coxarthrosis. In such a situation, a more complex and expensive surgical intervention will be required - hip replacement with the replacement of its natural components with artificial prostheses.
After surgery, a rehabilitation program is individually developed for each patient. Usually it lasts 3 months, but you can walk almost immediately after the operation. This will require crutches for the first 2 weeks, after which they are gradually abandoned. But they continue to monitor the intensity of the load on the operated limb. During the entire recovery period, it is required to engage in exercise therapy according to an individually designed program.
Rehabilitation after hip arthroscopy
In the first days after surgery, doctors prescribe painkillers and anti-inflammatory drugs to patients. In parallel with this, the medical staff carefully cares for the postoperative wound and monitors the patient’s adequate motor activity. It is important that in the first 7-10 days the person loads the operated limb by 50%, and his gait is symmetrical.
From the second or third week, the patient is prescribed water treatments and a set of physical exercises. After another 2-3 weeks. Manual therapy is added to the treatment, and physical activity is increased. At 8-12 weeks a person usually practices independently. As a rule, he performs exercises aimed at strengthening the hip joint. At the end of this period, he returns to his usual level of physical activity.
Judging by patient reviews, hip arthroscopy is a painless and low-traumatic operation. If the surgical intervention is successful and there are no complications, most patients return to their normal lifestyle.
Symptoms of hip impingement syndrome
The most striking symptoms of the disease are pain and limited mobility of the hip joint. As a rule, patients complain of:
- pain that can be felt both in the joint itself and in the groin, buttocks, and even radiate to the lower back;
- sudden onset of pain in the joint when performing leg movements to the limit position;
- persistent limitation of the possible range of movements;
- increased pain after prolonged sitting or heavy physical activity;
- reduction of pain after rest.
In rare cases, the development of hip impingement syndrome is asymptomatic.
However, the symptoms characteristic of impingement syndrome are not unique. A number of pathologies of the hip joint and even other parts of the musculoskeletal system can manifest themselves in a similar way. Therefore, it is impossible to make a diagnosis based on the clinical picture alone.
Complications after hip arthroscopy
In recent years, arthroscopy has become increasingly popular. However, as the number of arthroscopic interventions increases, the total number of complications also increases. Fortunately, they are mostly temporary and appear in only 0.5-6.4% of cases. But sometimes patients experience serious consequences that reduce their ability to work in the future.
On the Internet you will find practically no information about the negative consequences of arthroscopy. On all sites, the authors describe only the advantages of the operation. Therefore, we will pay a little more attention to this topic.
Table 1. Possible complications of arthroscopic operations.
| Complication | General information | Prevention measures |
| Distraction neurapraxia | It occurs due to prolonged traction on the hip joint, which can last several hours. As a result, the patient develops ischemia and damage to the femoral or sciatic nerve. Pathology is a violation of the conduction of nerves while maintaining their continuity. | Limiting periods of continuous traction helps to avoid complications. It is best that they last less than 2 hours and alternate with intermittent traction efforts. The force applied to the hip joint should not exceed 22.7 kg (50 lbs) in any case. To prevent neuropraxia, doctors have also developed a technique for invasive destruction of the hip joint. Its essence lies in the use of traction focused only on the joint area. |
| Iatrogenic damage to cartilage or acetabular labrum | Articular structures can be damaged during penetration into the joint cavity or during intra-articular manipulation. The front or upper part of the lip is most often affected. | To prevent damage to intra-articular structures, it is necessary to perform distraction of the hip joint by at least 10 mm. This can be done by intrasynovial injection of 20-40 ml of saline solution. The liquid stretches the joint cavity, which makes the surgeon’s manipulations much safer. |
| Irrigation fluid leak | The pathology is characterized by the penetration of fluid from the synovial cavity into the anatomical spaces located near the hip joint. Quite often, saline solution gets into the abdominal cavity. There have been cases where the leak has resulted in femoral nerve palsy. | To one degree or another, fluid will always leak from the synovial cavity. There is no way to avoid this. But its leakage can be reduced by performing an economical capsulotomy and minimizing the surgical time. During arthroscopy, doctors must monitor fluid balance and ensure that its pressure does not exceed normal (40-50 mm Hg) |
| Infections | Arthroscopy is a long-term operation that involves the introduction of instruments and foreign materials into the joint cavity. Naturally, during manipulations, doctors risk introducing an infection. | There are no recommendations in clinical protocols for the prevention of infectious complications. For this purpose, some experts recommend administering a single dose of a broad-spectrum antibiotic to the patient once. An intramuscular injection should be given before surgery. |
| Deep vein thrombosis of the lower extremities | Thromboembolic complications develop in 2.8-3.7% of patients. Fortunately, they respond well to treatment and do not leave behind serious problems. In rare cases, patients may experience pulmonary embolism. | Individual pharmacological prophylaxis and early postoperative mobilization (preferably on the day of surgery) help to avoid thrombosis. For preventive purposes, doctors put special elastic stockings on the patient’s healthy limb during the operation. |
| Tool failure | The hip joint is surrounded by a wide layer of soft tissue, which creates difficulties in obtaining surgical access to it. This, together with the pronounced curvature of the articular surfaces, significantly increases the risk of breakage of arthroscopic instrumentation. | To prevent instrument breakage, the surgeon must insert them with extreme caution. He must work in the synovial cavity slowly and extremely carefully. Naturally, all arthroscopic manipulations must be performed with a sufficiently expanded cavity of the hip joint. |
Removing the suture material fixator, which broke when trying to fix the damaged acetabular labrum.
Hip arthroscopy is performed in Moscow, St. Petersburg and other large cities of the Russian Federation. You can have surgery in any of them or go to a European clinic. Abroad, arthroscopic operations are performed with better quality. So if you want to avoid unpleasant complications, go abroad.
Possible complications
Complications are rarely reported during hip surgery. But still there is always a small risk. It occurs if the patient neglects the doctor’s recommendations or the arthroscopy technique is violated.
What can happen:
- impaired joint mobility;
- tissue trauma;
- violation of the integrity of blood vessels and nerve fibers;
- acute inflammatory processes.
There is no need to be afraid of this if you choose a clinic with documentation confirming the skills of its specialists and follow the doctor’s instructions.
Rating of clinics for hip arthroscopy
Arthroscopic interventions in Russia are performed in public and private clinics. Please note that prices for hip arthroscopy in Moscow can vary widely. They depend on the equipment of the hospital and the qualifications of the specialists working there.
If it is important for you to maintain a good functional state of the hip joint, think about treatment in Europe. Be sure to pay attention to the Czech Republic, where you can be offered high-quality medical care for relatively little money.
Clinic of sports, ballet and circus trauma of the Federal State Institution CITO named after. Priorova
This is exactly the place in Moscow where hip arthroscopy is performed for professional athletes and leading ballet dancers. The clinic has 4 operating rooms equipped with high-quality modern equipment. Here you can undergo surgery and undergo comprehensive rehabilitation, including massage, physiotherapy and exercise therapy with an instructor.
The cost of hip arthroscopy in this clinic is 36,000 rubles. You will also need to pay additionally for rehabilitation measures.
CYTO.
Federal State Budgetary Institution "National Medical Clinical Center named after N.I. Pirogov" of the Ministry of Health of Russia
At the National Medical and Surgical Center named after. Pirogov employs the best specialists in hip arthroscopy in Moscow. Here they treat ruptures of the labrum, severe inflammatory diseases of the hip joint, damage to cartilage tissue, impingement syndrome of the Pincer, Cam and Mixed types. Surgical interventions are often performed by candidates and doctors of science. The price for hip arthroscopy at the Center is 40,800 rubles.
National Medical Center named after N.I. Pirogov.
Central Clinical Hospital RAS
This is a large institution of the Russian Academy of Sciences. Surgical interventions on joints are performed here on the basis of the orthopedic department of the Trauma and Orthopedic Center. The cost of the operation is 15,000 rubles.
Central Clinical Hospital RAS
Road Clinical Hospital named after. N.I. Semashko
The medical institution is equipped with the latest equipment that allows performing arthroscopic interventions of any complexity. Hip arthroscopy will be done here for 10,500 rubles.
Road Clinical Hospital named after. N.I. Semashko