Hips

Hip arthroscopy

While arthroscopy is already used as a matter of course for knee or shoulder joints, arthroscopy of the hip joints is still rather rare. Hip arthroscopy has the advantage of being a minimally invasive procedure, with only three small incisions required. The alternative involves opening up the entire joint (to do this, a bone must be sawed, the hip dislocated, and the bone rescrewed after the operation), which obviously involves much greater postoperative pain.

The following hip problems can be treated well with arthroscopy:

Femoroacetabular Impingement (FAI):
Runners and football players often suffer from hip pain of unknown origin that radiates from the groin back towards the buttocks. This can often make internal rotations with a flexed hip very painful. The most common cause of such symptoms is femoroacetabular impingement (FAI). The cause of FAI is an incongruence of the acetabulum and femoral head that causes pronounced friction, leading to labrum injury and/or rapidly progressing cartilage damage.

The incongruence can have two root causes:

1) the femoral head is not as round as it should be. This is known as cam impingement (see image) 
2) a pronounced covering of the acetabulum (this can be congenital, or may develop over decades). This is called pincer impingement (see image). Most patients (86%), however, suffer from a mixed type of impingement, with cam impingement being predominant in young athletes and due to the head of the femur being subobtimally positioned genetically. Diagnosis: Clinical examination, MRI, possibly also a CT exam Treatment: For cam impingement, the transition of the head to neck of the femur can be arthroscopically reshaped by ensuring that just the right amount of bone is removed. For pincer impingement, projecting sections of the acetabulum must be removed, something that can be difficult to carry out using arthroscopy.
Most patients (86%), however, suffer from a mixed type of impingement, with cam impingement being predominant in young athletes and due to the head of the femur being subobtimally positioned genetically.
Diagnosis: Clinical examination, MRI, possibly also a CT exam
Treatment: For cam impingement, the transition of the head to neck of the femur can be arthroscopically reshaped by ensuring that just the right amount of bone is removed.
For pincer impingement, projecting sections of the acetabulum must be removed, something that can be difficult to carry out using arthroscopy.

Floating bodies:
Caused either as a result of cartilage injury or due to degeneration of the joint, pieces that are freely floating around the joint can become wedged and cause severe pain. These pieces can usually be easily recovered using arthroscopy.

Labrum Injuries:
The labrum is a cartilaginous strengthening ring in the acetabulum and can either be torn by an injury (frequently seen in ball sport athletes) and/or due to overstraining (such as in the case of femoroacetabular impingement). Depending on the extent of the injury, the labrum can be smoothed or in some cases even completely reattached.

Coxa saltans (snapping hip):
It is generally young female athletes who are afflicted by this uncomfortable and painful snapping sensation in the hip. The cause is often a prominent osseous protuberance slightly beneath the femoral head (which the iliopsoas tendon runs across) that can either be milled or a groove incised into the affected muscle using arthroscopy. Another cause of a snapping hip can be an injury to the labrum.

Cartilage damage:
Cartilage damage in the hip caused by injury can be treated very well using arthroscopy. See also cartilage.

Hip Replacement

Bei ausgeprägten Abnutzungen des Knorpels (Arthrose) und entsprechender klinischer Symptomatik (v.a. Schmerzen beim Aufstehen, Gehen, oder auch Schmerzen in der Nacht) ist die Implantation einer Hüftprothese unumgänglich. 
Die entsprechende Abklärung erfolgt durch die klinische Untersuchung, Röntgenbilder, ev. auch MRI. 
Das Einsetzen der Hüftprothese erfolgt inzwischen schon um vieles schonender als noch vor zehn Jahren. Es sind inzwischen minimal invasive Techniken verfügbar, durch die Muskelschäden weitgehend minimiert werden können.