The hip joint ANATOMY

The hip joint is complex, and is designed to allow a wide range of movements so that we can carry out our daily activities. Main muscle groups connect and cross the hip joint, allowing a person to perform movements such as walking and accelerating rapidly as when running and jumping. The joint consists of the acetabular socket (acetabulum), the space which holds the head of the femur. As with other joints, the surfaces of the two bones meet in the joint (the pelvis acetabulum and the top of the bone) are covered with a smooth surface called cartilage. The cartilage works like a sponge in the joint, allowing lubrication between the two surfaces.

Furthermore, the acetabulum is surrounded by a cartilage ring called the labrum to protect the joint, producing an empty join to ensure the ball bone to fit into the socket.

HIP ARTHROSCOPY

At the end of the last century, Dr Ganz discovered a technique to remodel deformed cartilage that lead to an important approach with bone osteotomy. Later, Doctors Vilarrubias and Ribas discovered a new minimally invasive technique that saved the osteotomy and reduces the aggresivity of the surgery and considerably improves the results and recovery.

The medical team of IQTRA, lead by Dr Angel Villamor has been using during the last few years this technique and in 2007 started to treat the femoro-acetabular impingement impact by arthroscopy, with excellent results, without requiring surgery and with a rapid recovery in the majority of cases, producing clinical results comparable to the results of open surgery.

For the development of this technique, during 2007 Dr Vilamor’s team worked with Dr Richard Villar in London, and with Dr Mark Phillipon in Colorado (USA), who has published series of articles on hip surgeries performed by arthroscopy, showing that in 90% of cases have lead to many sportspeople being able to return to their previous level of competition.

The arthroscopy technique for the hip follows the same route as two decades ago with the arthroscopy surgery on the shoulder. It’s adoption was at first uncertain although after the initial trials lead to greater precision which was less aggressive and quicker to perform, and enabled easier recuperation and meant that patients could lead a better quality of life.

As the hip has more movement, the risk for open surgery is greater than for any other type and the specialists of IQTRA believe that the hip joint will benefit the most from this kind of arthroscopic technique. The development of this technique and the work done by medical teams has advanced it’s application and has made us much more optimistic to state that this type of pathology is safe and has an excellent success rate. It is also being used to treat small injuries that, if open surgery was used, would lead to a longer recuperation time.

 

Anatomía de la cadera y equipo de medicos operando por artroscopia

 

Injuries that can be treated using arthroscopic hip surgery

  • Femoro-acetabular Impingement
  • Labrum tears
  • Removal of free bodies: small parts of cartilage that after an injury have become detached and can damage the joint
  • And in general patients selected in a case-by-case basis, when there is an opportunity to preserve the cartilage.

The hip arthroscopy procedure is a minimally invasive surgery, using 2 or 3 small incisions of approximately 1 cm long, avoiding an open surgery incision. Through these incisions, the surgeon inserts the instruments into the joint. A Fluoroscope (x-ray) image is helping the surgeon to ensure the instruments are located properly.

After the surgery the patient will rest one nigth at the hospital to recover from the anaesthesy and will be able to return home the following morning. In almost all the cases, the pain has significantly been relieved.

FEMORO-ACETABULAR IMPINGEMENT

The Orthopedic Department of Iqtra began using arthroscopy for this condition in 2007, which is estimated to affect 15% of the population.

Early diagnosis and treatment of the femoro-acetabular impingement from the first GP visit, can avoid up to 70% of the hip prothesis’ that are implanted in patients of less than 50 years of age. The cause of which is unknown, can affect either of the two elements present in the use of the hip: the acetabulum and the femur. When the extra bone on the femoral head and/or neck hits the rim of the acetabulum, the cartilage and labrum that line the acetabulum can be damaged. The extra bone seems a very small bump, which repeatedly rubs against the cartilage and labrum (which serve to cushion the impact between the ball and the socket), the cartilage and labrum can fray or tear, resulting in pain. As more cartilage and labrum is lost, both bones (femur and pelvis) impact and result in arthritis pain. Tears of the labrum can also fold into the joint space, causing extra pain.

This anomaly starts to appear in most cases as pain in the front of the hip, greater trochanter area or glutes, and, sometimes as limitation of the hip movility. Most of the patients realizes for the first time, after prolonged sitting or walking or as result of sports activity that involves repetitive movements of hip flexion.

Pain is present during or after practicing sport, when sitting down or standing up after being sat down for a period of time. It’s is also possible to notice a slow loss of movement over the hip, sometimes without any form of pain.

Dr, Angel Villamor , Medical Director of iQtra, has been working with his team studying surgical techniques to treat this condition, and considers that “it is critical that General Practicioners, sports doctors, Orthopedic experts, rheumatologists and radiologists” work together to diagnose the problem correctly and to start treatment at an early stage, as the x-ray diagnosis is not difficult if the medical staff understand that this condition exists.

Before knowing about this condition, most patients were treated for tendinosis in the abductors, tendinitis of the pyramidal muscle or osteopathy of the pubis. These incorrect diagnoses also lead to the wrong treatment being applied.