Arthoscopy

Arthroscopy is a surgical procedure in which the orthopedic surgeon makes a small incision in the patient’s skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Developmental dysplasia of the hip is one of the most common reasons leading to symptomatic hip arthritis. Various methods have been proposed to minimize the problems potentially resulting from abnormal hip joint contact pressure generated by the lack of femoral head coverage. The morphology and the organization of the acetabulum, which is typically shallow and anteverted, and the femoral head which is lateralized, can result in abnormally high contact pressure at the articular margin of the acetabulum. The resultant altered hip biomechanics can cause labral tears, chondral lesions, ligamentum teres (LT) injuries, hip instability or impingement. This can ultimately lead to degenerative hip disease that may necessitate joint replacement. Depending on the symptoms and the degree of dysplasia, treatment can be varied. In the recalcitrant conditions with moderate or severe dysplasia, the recommended definitive treatment involves reconstructing the acetabular roof. Previous literature has reported promising outcomes when the patient is treated with appropriate pelvic osteotomy procedure but the surgical procedure is associated with high morbidity and has been reported to cause a number of complications. With the recent advances in hip arthroscopy in terms of instrumentation and techniques, the treatment of intra-articular pathologies which once was believed to require open surgery can be now performed with minimal incision and free of muscle and tendon damage.

The idea of treating hip conditions with arthroscopy in the dysplastic hip has been negatively viewed based on the concept that the contact pressure is directed toward the lateral edge of the acetabulum. This, in turn, will cause early degeneration if the underlying bone structure is uncorrected. However, there is a paucity of literature on how the arthroscopic treatment will affect the dysplastic hip and the current concept is mostly derived from expert opinions based on biomechanics studies.