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    Indications and Contraindications for Hip Arthroscopy

    Hip arthroscopy is becoming a very common procedure: In 2008, about 30,000 hip arthroscopies were performed in the US; the Mayo Clinic estimates that number jumped to 70,000 in 2013.

    The American Board of Orthopaedic Surgery reported that among surgeons who did the Part II exam, there was a 600% increase in hip arthroscopy cases from 2006 to 2010.

    Given this rapid increase, hip arthroscopy must be the “magic bullet” for treating hip pathologies, right?

    Not exactly.

    Although the spectrum of hip pathologies that can be treated with arthroscopy is expanding, there are still distinct indications and contraindications for the procedure. Christopher L. Peters, MD, for the University of Utah in Salt Lake City, addressed this issue at ICJR’S Winter Hip & Knee Course in Vail, Colorado.

    In the past, Dr. Peters said, hip arthroscopy was limited to treatment of a number of intra-articular pathologies, such as chondrolabral damage, femoroacetabular impingement (FAI), labral tears, loose bodies, and (PVNS).

    More recently, the indications have expanded to include several peri-articular pathologies, such as psoas impingement/snapping, peri-trochanteric space disorders, ischio-femoral impingement, subspine impingement, gluteus medius tears, and abductor dysfunction.

    Dr. Peters takes a conservative view of the indications for the procedure, and he makes a distinction between clear indications and evolving indications.

    He said the clear indications for hip arthroscopy are:

    • Labral tear
    • FAI
    • Loose bodies
    • PVNS
    • Central compartment disease

    There is now good evidence in the literature that labral tears and FAI treated arthroscopically do well at 10 years of follow-up, as long as the underlying structural abnormality addressed.

    Dr. Peters feels the following indications for hip arthroscopy are still evolving:

    • Peri-articular space disorders
    • Gluteus medius/minimus tears
    • Greater trochanteric bursitis
    • Ischio-femoral impingement
    • Subspine impingement

    Early results of arthroscopic treatment of gluteus medius/minimus tears and greater trochanteric bursitis have been quite good, as long as the procedure was performed well, offering a promising treatment for pathologies often refractory to prior treatment.

    Dr. Peters said the contraindications to treatment with hip arthroscopy are, in a sense, also the indications for open procedures:

    • More complex/extensive pathomorphology, such as posterolateral extension of CAM and global rim trim and pediatric disease sequelae including Perthes disease and SCFE
    • Early in the learning curve
    • Large chondral delamination
    • Extensive rim work/complex labral reconstruction
    • Very young patients

    Dr. Peters cautioned that hip arthroscopy is not the answer for every patient. In fact, in a few pathologies – such as labral tears in patients with developmental dysplasia of the hip – attempting arthroscopic treatment can be directly detrimental to the outcome. A study by Parvizi et al [1] showed that prior arthroscopy in these patients tended to compromise a salvage operation such as peri-acetabular osteotomy.

    Dr. Peters’ presentation can be found here.

    Reference

    1. Parvizi J ,Bican O ,Bender B ,Mortazavi SM ,Purtill JJ ,Erickson J ,Peters C. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 2009 Sep;24(6 Suppl):110-3. doi: 10.1016/j.arth.2009.05.021.