The hip joint is one of the body's largest weight-bearing joints and is the point where the thigh bone (femur) and the pelvis (acetabulum) unite. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket.
The trochanteric bursa is the large sac present above the greater trochanter of the femur. The iliotibial band is the ligament that crosses the hip joint, runs down the lateral thigh and attaches to the knee; the band helps stabilize and move the joint.
Hip endoscopy is a minimally invasive procedure indicated in the treatment of various disorders of the hip such as external snapping hip syndrome, internal snapping hip syndrome, gluteus medius tears, and greater trochanteric bursitis.
The aim of the procedure is to relieve chronic debilitating hip pain. Portal incisions are one of the most challenging aspects of hip endoscopy. The incision locations depend on the surgeon's preference and the pathology being treated.
External snapping hip occurs when the IT band snaps over the prominence of the greater trochanter during flexion and extension. During hip endoscopy, a diamond shaped defect is created on the IT band lateral to the greater trochanter and the IT band is released. The diamond shaped defect allows free mobility of the greater trochanter and prevents snapping of the IT band. The surgery is performed outside the hip joint, in the peritrochanteric space.
Internal snapping hip occurs when the iliopsoas tendon snaps over the femoral head, and mostly occurs with hip extension from a flexed position of greater than 90 degrees. Endoscopic treatment involves release of the iliopsoas tendon at the level of the hip joint or at the insertion of the iliopsoas tendon on the lesser trochanter.
Endoscopic procedures use minimally invasive techniques; a smaller incision is placed than the traditional large open incision. Some of the benefits of endoscopic procedures include:
- Minimal trauma to the surrounding tissues
- Shorter recovery time with minimal post-surgical complications
- Greater range of motion with less post-operative pain