Whilst arthroscopic (keyhole) surgery to large joints such as the knee and the shoulder is widely used, arthroscopy of the hip is performed much less frequently. This is because the hip joint is deeply seated and relatively inaccessible, as well as traction being required to produce a gap between the ball and socket into which instruments can be introduced. Fortunately, modern equipment and advances in surgical technique have made arthroscopic hip surgery safe and reliable surgery in the hands of experienced surgeons. Mr Bankes has been performing hip arthroscopy since 2003 and performs at least 100 arthroscopic hip operations per year.
The key feature to understanding sporting hip injuries is that the pain comes from damage to structures at the front of the hip joint, namely the acetabular labrum and the articular cartilage at the front edge of the hip joint. It is for this reason that the symptoms are similar irrespective of the type of injury ie whether the labrum is torn, the cartilage is detached or a combination of the two. In addition, the symptoms are similar regardless of the cause of hip injury be it FAI, hip dysplasia or a simple labral tear without predisposing bony abnormality. Sports associated with hip injuries include running, rugby, martial arts, squash, tennis and football.
Hip injuries may be felt as an insidious onset of deep groin pain present during or immediately after exercise, although the hip may be stiff and sore for a day or two afterwards. This may lead to a change in exercise type and intensity such that patients may give up running and move to something with less impact such as cycling. Intermittent catching, locking or sharp pain in the groin with flexion or twisting manoeuvres may be present. Ability to run in a straight line is often maintained but patients experience pain trying to change direction. This is particularly problematic for racket sports and football. As symptoms progress they may start to affect everyday life and may be present walking, getting up from a chair, or even reaching down for shoes and socks or to pick something off the floor. Prolonged sitting upright can also be a problem and activities such as driving, long flights or working at a desk. Patients may only be able to get comfortable by slouching or sitting in particular positions.
X-rays and scans
Identifying subtle bony abnormalities and injuries relies heavily on modern imaging techniques. A thorough assessment can only be made with a combination of x-rays, and CT and MRI scans. Each method of imaging gives different information about the hip; the x-ray is like the aerial photograph, the MRI is like the street atlas, and the CT is like the architect’s plan. Each has its own vital role to play in providing information about the hip.