Preserving, in medical terms, can be defined as “protecting from possible or probable harm, or from any unwanted event.”
Preservation surgery consists of operating on an incipient disorder so that its evolution does not cause a major alteration that deteriorates the patient’s quality of life.
To perform these techniques, we have a wide range of treatments, including arthroscopy treatments, osteotomies, corrective techniques by safe dislocation, treatment of cartilage injuries (repairs, debridements, culture of chondrocytes, …), techniques of repairs of the labrum and replacement of it by grafts.
IS IT A PASSING FAD ?
The interest, in relation to surgical treatments for hip preservation, and more specifically in relation to arthroscopy, is growing. There is even talk of the last great revolution in the field of orthopedic surgery. In the U.S., between 2006 and 2010, an expansion of the arthroscopic hip technique was estimated to exceed 500%. What is clear, is that there is an increase in the number of treatments performed, and publications in medical journals.
It is obvious the rapid growth of arthroscopic treatment in the last 10 years, especially in terms of arthroscopic treatment of femoroacetabular shock.
In the same way, it should be noted that arthroscopy has helped us to better understand and visualize the hip joint, as well as to understand the morphological alterations of the same, especially in relation to shock and its different manifestations (CAM type, PINCER and MIXED).
HIP ARTHROSCOPY, FOR ALL PATIENTS?
All surgical treatments must be based on indications that allow their correct realization and the obtaining of good results.
Hip arthroscopy can be performed in all patients (men or women), who have pain and who have any alteration that can be treated arthroscopically.
Hip arthroscopy should be indicated appropriately, avoiding performing it in those patients whose degree of joint degeneration (osteoarthritis) is evolved, as well as in cases in which there is a severe alteration of the anatomy of the joint
EFFECTIVENESS OF HIP ARTHROSCOPY
What evidence is there for hip arthroscopy? Today, we have multiple publications that support arthroscopic treatment to treat different hip conditions.
In 2010, Stevens et al. (1) published one of the first papers talking about the evidence for arthroscopic treatment of femoroacetabular shock, identifying a reasonable degree of evidence to support the use of arthroscopy for the treatment of shock.
In 2011, the NICE (National Institute for Health and Care Excellence) guidelines showed adequate evidence regarding the efficacy of hip arthroscopy in the treatment of shock. Other more recent publications, such as that of Khan M et al. (2) show improvements in the functional outcomes of arthroscopically treated patients with fémoroacetabular shock.
The Warwick Consensus (3) led by Dr. Griffin, in collaboration with different specialists from around the world, showed once again, the benefits of arthroscopic technique for the treatment of shock.
A few months ago (June 2018) they published the results of the Fashion study (4). This study has been conducted in the UK with the participation of 23 hospitals and almost 350 patients. This is a study with powerful scientific evidence, which supports the use of arthroscopic treatment in patients with femoroacetabular shock and evidences that arthrocopy is superior to any other treatment in patients with femoroacetabular shock.
COMPLICATIONS OF HIP ARTHROSCOPY
Contrary to what it may seem, the complication rates of arthroscopic hip treatments are low. These complications, and the rates of reintervention are directly related to the learning curve of the arthroscopic technique and the indications at the time of performing the treatment.
Overall, complication rates range from 0.58% to 7.5%, (5)
Cartilage injury and temporal nerve disorders (neuroapraxia) are the two most frequently reported complications.
Hip arthroscopy is considered as an adequate treatment of femoroacetabular shock, produces improvements in symptoms and improvements in joint function.
We must always assess the age of the patients and the state of the cartilage. Some publications show reintervention rates, after hip arthroscopy, of up to 6.3%, the most frequent reintervention was total hip arthroplasty.
The arthroscopic technique in the hip, is acceptable in terms of complications.
The most recent studies and publications demonstrate the efficacy of surgical treatment for femoroacetabular shock.
1. Stevens MS, Legay DA, Glazebrook MA, Amirault D. The evidence for hip arthroscopy: grading the current indications. Arthroscopy 2010 Oct ;26 (10): 1370-83
2. Khan M, Habib A, de Sa D, Larson CM, Kelly BT, Bhandari M, Ayeni OR, Bedi A. Arthroscopy Up to Date: Hip Femoroacetabular Impingement. Arthroscopy 2016 Jan;32 (1): 177-89
3. Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Beck M, Martin HF, Awan T, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin R, Mather RC, Philippon MJ, Reinman MP, Takla A, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement
4. Griffin DR, Dickenson EJ, Wall DH, Achana F, Donovan JL, Griffin J, FASHIoN Study Group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018 Jun 2;391(10136):2225-2235.
5. Arthroscopy. 2013 Mar;29(3):589-95. doi: 10.1016/j.arthro.2012.11.003.
Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients.
Harris JD1, McCormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR Jr, Bush-Joseph CA, Nho SJ..