Indications for Hip Arthroscopy

The hip is a deep joint, and mechanical degradation can occur early in life due to risk factors such as sports activities (combat sports, team sports, dance), trauma, or following a childhood pathology that is sometimes congenital.

Coxopathy and Arthroscopy

The most common indication for hip arthroscopy is femoroacetabular impingement. The combination of a malformation (femoral cam or acetabular pincer) and participation in high-risk sports leads to joint lesions affecting the acetabular labrum and then the cartilage. The progression to arthritis is inevitable if the joint’s mechanical conditions are not corrected. In this context, arthroscopy is the reference technique for exploring the lesions of the impingement and then correcting the femoral cam (femoroplasty) and/or the acetabular pincer (acetabuloplasty). The labrum is repaired or resected depending on the type of lesion observed. The cartilage is treated by resection in cases of unstable flaps.

Villonodular synovitis and hip chondromatosis are rare indications for arthroscopy, often delayed due to difficult diagnosis.
Coxarthrosis is generally not an indication for arthroscopy, except in certain cases of moderate arthritis associated with aggressive osteophytes or hip impingement.

Diagnostic Approach

Before deciding on hip arthroscopy, it is necessary to perform a complete radiological assessment to screen for any severe dysplasia that would contraindicate the procedure. X-rays help to classify the stage of arthritis and to highlight any associated malformations: femoral cam, acetabular pincer, coxa vara or coxa valga, coxa profunda, acetabular protrusion.

Since the labrum, cartilage, and ligaments are not visible on X-rays, it is then appropriate to use sectional imaging to identify potential lesions. Arthroscopy requires the injection of a contrast agent and can be combined with a cortisone or hyaluronic acid infiltration; the cartilage and labrum are very well visualized. MRI or arthro MRI provide additional information such as the presence of subchondral suffering (bone edema), a cyst, or an associated tendinopathy.