User login
Hip Arthroscopy (HAS)
The concept of looking inside of a joint through a small incision without major open surgery is rather old. Originally, this was done with optics. Today arthroscopy is performed using a high-resolution camera (arthroscope). The technique of arthroscopy was first mentioned in the literature by the Japanese surgeon Kenji Takagi in 1918.
In 1931, Michael Samuel Burman published the first detailed description: "Originally, we were sceptical as to whether anything could be seen in the hip joint, but we have had unusual success with this puncture".
In the late 1980s and early 1990s, J. W. Thomas Byrd of the USA and R. N. Villar of the UK were the main proponents of hip arthroscopy.
As fate would have it, I was in Boston (USA) at the right time and was able to take part in the entire process of development of modern hip arthroscopy right from the beginning.
We spent night after night at the Biomechanics Lab optimising the technique and determining the best access sites for positioning the camera and special instruments. We also started to develop the necessary instrumentarium because no suitable instruments were available then. Today, this set of instruments is made in Switzerland and used worldwide.
After I returned to Switzerland, we started performing hip arthroscopy in 1996—a time when most people still believed that such a minimally invasive procedure was not possible. Naturally, we were in constant contact with the research groups in the USA and UK. We soon discovered that arthroscopy can be used not only to examine and diagnose the joint, but also to perform treatment procedures. This made it possible to identify and—in an increasing number of cases—successfully treat entirely new disease entities, albeit with the relatively simple technology available at that time. We performed our first arthroscopic hip labral tear surgery in 1996, removing the torn portion of the labrum. The patient, a woman who will soon turn 75, is still in a mainly symptom-free state.
Rapid developments in the field of hip arthroscopy followed. At the world's largest congress of orthopaedic surgeons in 2003, experts concluded: "There is no longer any reason to perform a joint-preserving hip surgery as open surgery. With good technique, these procedures can all be performed arthroscopically." Arthroscopic surgery naturally has tremendous advantages.
On that occasion, our group published an article in a Swiss journal, which you may be interested in reading. It provides a great deal of additional information.
This was the definitive breakthrough for hip arthroscopy, which is quite clearly the international "gold standard" today.
Nonetheless, hip arthroscopy is technically demanding, and centres performing hip arthroscopy must have not only the necessary technical equipment, but also a well-trained team who know how to use it. Further details can be found in the following presentation.
Welchen Sport mache ich jetzt zuerst?
Hip arthroscopy is most commonly performed for treatment of hip impingement syndrome. This is also described in a separate chapter: Hip Impingement.
As one of the largest orthopaedic surgery centres in Europe, we perform an average 250 to 300 hip arthroscopies per year. Our patients come from all parts of Europe, especially Germany, Austria, Belgium and France.
The number of top international athletes we operate on has also increased tremendously. After hip arthroscopy, most athletes can start a specific sports rehabilitation programme allowing them to resume their sports activities, which was rarely the case after conventional open hip surgery.
We will gladly help you put together a rehabilitation programme for your specific needs. However, when performing these rehabilitation exercises as well as the physiotherapy exercises, it is important to always remain within the pain-free range of motion. The cross trainer—a piece of equipment available in almost all fitness centres today—is virtually ideal for postoperative rehabilitation.