Hip arthroscopy in osteoarthritis: Is it an option?

Abstract

Arthritis of the hip is a degenerative disease characterised by pain and inflammation. It is common and most often affects middle-aged to older adults, with the definitive management being total hip replacement. Advances in the surgical techniques has brought about the popularity of hip preservation surgery in patients with pre-arthritic hip abnormalities, with a goal to prevent progression to early arthritis and subsequently prolong the need for arthroplasty. There is a large body of evidence correlating femoroacetabular impingement (FAI) and the progression of osteoarthritis. Hip arthroscopy is a successful technique in the management of FAI and labral damage. There is, however, less evidence behind its use in those patients with established arthritic changes. After review of such evidence, we believe hip arthroscopy, and other hip preservation procedures, have a key role, and should be considered in the management of early hip arthritis. However, there is no role for such procedures in end-stage arthritis.

Keywords: Femoroacetabular; Hip arthroscopy; Hip preservation surgery; Impingement; Osteoarthritis.

Fig. 1

Flow-chart outlining the progression to End-Stage Arthritis.

Fig. 2

Left Hip arthroscopy being performed for patient with SUFE, previously managed with in-situ fixation. CAM deformity evident on this image.

Fig. 3

Flow diagram created by Domb et al. – ‘Proposed algorithm for patient selection for hip arthroscopy using radiographic parameters as a guide.’.

Fig. 4

MR Arthrogram of Left Hip. (A) Sagittal STIR sequence and (B) Axial STIR sequence showing fraying and irregularity of acetabular labrum with infiltration of contrast.

Fig. 5

MR Arthrogram of Left Hip. (A) Sagittal STIR sequence and (B) Coronal STIR sequence showing area of bright signal intensity to posterior margin of acetabular labrum representing subchondral geode, measuring 1.2 cm across.

Fig. 6

Photographs of surgical hip dislocation procedure with OATs. (A) Dislocated femoral head showing 1 cm area of cartilage loss superolaterally, with donor site present inferomedially. (B) Recipient site post-curettage. (C) Successful transfer of bone from donor site to recipient site to fill the defect.