Arthroscopic hip surgery

For the treatment of

Labral tear or Femoro-Acetabular Impingement (FAI)
Sepsis of the hip joint
Loose body

Commissioning position

Labral tear or Femoro-Acetabular Impingement (FAI)

Arthroscopic hip surgery is commissioned if ALL the following criteria are met:

there is a diagnosis of definite labral tear and/or Femoro-Acetabular Impingement Syndrome (FAI) through clinical and radiological investigation (e.g. X-rays, MRI, CT scans) AND
an Orthopaedic Surgeon who specialises in young adult hip surgery has made the diagnosis, which should include discussion with a specialist Musculo-skeletal radiologist AND
there are severe symptoms and compromised function measured by objective scoring tools and with a duration of at least six months when a diagnosis of FAI has been made AND
symptoms have failed to respond to conservative treatment including activity modification, specialist physiotherapy and maximal pharmacological interventions for at least 6 months AND
treatment with hip replacement, resurfacing or other more established procedure is not clinically viable AND
the patient is aged between 18 and 50 years

Sepsis of the hip joint

Arthroscopic hip surgery is commissioned as part of the management of an infected native hip joint.

Loose body

Arthroscopic hip surgery is commissioned for removal of radiologically proven loose bodies within the hip joint causing persistent pain and/or compromising function when symptom onset followed acute trauma to the same hip.

Arthroscopy is not commissioned for diagnostic examination when a loose body is suspected or for indications other than stated above.

Summary of rationale

Labral tear and FAI

The aim of arthroscopic femoro–acetabular surgery for hip impingement syndrome is to reduce pain and improve the joint range of movement. Current evidence on the efficacy of arthroscopic femoro–acetabular surgery for hip impingement syndrome is adequate in terms of symptom relief in the short and medium term. Adults aged <50 years are the most likely to gain the greatest benefit. With regard to safety, there are well recognised complications.

Arthroscopic femoro–acetabular surgery for hip impingement syndrome should only be carried out by surgeons with specialist expertise in arthroscopic hip surgery. The British Hip Society maintains a non-arthroplasty hip surgery register and surgeons should submit details of all patients undergoing this procedure to the register.

Sepsis

Arthroscopic lavage (with synovectomy, depending on the clinical stage) is recommended, particularly in larger joints. Patients with underlying disease, such as rheumatoid arthritis and diabetes, or the immuno-suppressed, benefit from earlier surgical intervention.

Loose bodies

Acute trauma frequently causes a fragment of bone or articular cartilage to become loose in the hip joint. Sometimes this will cause persistent pain and/or compromised function. Open surgery to remove a loose body carries a higher risk of complications than arthroscopic removal.