Hip arthroscopy, also known as hip endoscopy, has become established in recent years as a minimally invasive procedure for certain hip problems. It allows surgeons to look inside the joint through small incisions and treat tissue damage at the same time. Especially for active, athletic patients or young adults suffering from hip pain, this procedure seems like an ideal solution at first glance: less tissue trauma, shorter rehabilitation times, and the joint is preserved. However, these hopes are not always fulfilled – particularly in cases of hip dysplasia.

Hip dysplasia is one of the most common congenital malformations of the hip joint and affects many people, often without them noticing it for years. Over time, pain, mobility problems, and even osteoarthritis can develop. Many sufferers then seek the least invasive treatment methods possible to save their hip. Hip arthroscopy seems like a promising option – but the reality with hip dysplasia is often sobering. This article explores why this is the case and what alternatives exist.

What is hip dysplasia?

Hip dysplasia is a malformation of the hip joint in which the acetabulum does not adequately cover the femoral head. This leads to an incorrect distribution of pressure within the joint, which in the long term promotes cartilage damage, labral tears, and ultimately osteoarthritis.

Causes and origin

Hip dysplasia is usually congenital. Common causes include genetic factors, the baby's position in the womb, and certain risk factors such as breech presentation at birth. If it is not detected and treated early, it can lead to persistent pain and premature joint wear.

Symptoms

Typical symptoms are:

• Groin pain, especially during movement
• First hypermobility, then limitations in mobility
• Cracking noises in the joint
• Feeling of instability

Individual risk factors for hip dysplasia

Not all hip dysplasias are the same. The degree of malformation, the patient's age, activity level, and any existing comorbidities play a crucial role. Young, athletically active patients with mild dysplasia are particularly prone to considering arthroscopy – but it is precisely in these cases that the results are often disappointing. Precise diagnostics, including imaging and clinical examination, are therefore essential for making the right treatment decision.

Long-term biomechanical consequences of hip dysplasia

Untreated hip dysplasia leads to excessive stress on certain joint structures in the long term. The labrum, cartilage, and the bone itself are subjected to increased stress. Even if arthroscopy provides short-term relief, the underlying cause remains. The risk of early-onset osteoarthritis and ultimately the need for a hip replacement increases. Studies show that patients with dysplasia who undergo arthroscopy require a prosthesis on average sooner than patients without dysplasia.

Conservative alternatives in the treatment of hip dysplasia

Not every patient with hip dysplasia needs immediate surgery. In early stages, targeted conservative measures can help:

• Physiotherapy to strengthen the stabilizing muscles
• Pain therapy for symptomatic relief
• Hip-centering exercises to improve biomechanics
• Weight reduction to reduce joint stress

However, the fundamental problem remains: a malposition cannot be corrected conservatively. Therefore, these measures are more suitable for delaying surgery.

Hip arthroscopy (hip endoscopy) – what is it?

Hip arthroscopy (hip endoscopy) is a minimally invasive procedure in which a camera is inserted into the joint through small incisions. This allows the doctor to inspect the joint and treat any damage at the same time. Typical indications for hip arthroscopy include:

• Labral tears
• Cartilage defects
• Loose bodies in the joint
• Impingement (CAM or pincer impingement)

Procedure for hip arthroscopy (hip endoscopy)

The procedure is performed under general or spinal anesthesia. The leg is slightly extended to allow access to the hip joint. Through small incisions, the surgeon inserts a camera and specialized instruments. This allows them to inspect the structures within the joint and perform treatments such as cartilage smoothing, labral repair, or the removal of bone spurs.

Advantages of hip arthroscopy (hip endoscopy)

• Minimal incisions: Less scarring
• Faster recovery: Less tissue damage than with open surgery
• Targeted treatment: Direct access to joint structures

Good indications for hip arthroscopy (hip endoscopy)

While hip arthroscopy is often not advisable in cases of hip dysplasia, there are numerous other indications where it represents an effective treatment option. These include, in particular:

• Femoroacetabular impingement (FAI) : This bony deformity involves pinching between the femoral head and the acetabulum. Arthroscopy can remove excess bone material and improve mobility.
• Labral tears without structural dysplasia : In cases of traumatic labral tears, a repair can be performed that restores the function of the labrum.
• Cartilage damage : Isolated, non-degenerative cartilage defects can be smoothed or treated with modern cartilage therapies.
• Loose bodies in the joint : Detached pieces of cartilage or bone can cause blocking pain and can be removed arthroscopically.
• Synovitis (inflammation of the synovial membrane) : Inflamed mucous membrane can be removed, which reduces pain and inflammation.

The exact indication should always be determined by an experienced specialist after a thorough clinical examination and imaging.

Why hip arthroscopy is often unsuccessful in hip dysplasia

Hip arthroscopy cannot correct the underlying problem in hip dysplasia – the insufficient bony coverage of the femoral head. Here are the main reasons:

1. Biomechanical problems persist

The lack of coverage leads to increased stress on the labrum and cartilage. While arthroscopy can smooth or remove damaged structures, the underlying cause of the abnormal stress remains. This often results in the symptoms recurring after a short time.

2. Degenerative labral damage

In hip dysplasia, labral tears are usually not traumatic but degenerative. The labrum attempts to compensate for the lack of coverage, which leads to overloading. Removing the labrum can further impair stability, as it plays a crucial role as a sealing ring and shock absorber within the joint.

3. Risk of further instability

Dysplasia is inherently an unstable joint. Removing damaged tissue can exacerbate this instability, leading to even more pain and accelerated wear and tear.

4. Insufficient long-term results

Studies show that hip arthroscopy in patients with hip dysplasia often yields poorer long-term outcomes. Pain and restricted movement frequently recur because the underlying malalignment persists. This often leads to further surgeries.

5. Stress from repeated procedures

Many patients undergo further surgery after an unsuccessful hip arthroscopy – often a major one, such as a periacetabular osteotomy or even a hip replacement. This not only prolongs the overall treatment duration but also increases the physical and psychological strain.

When might hip arthroscopy still be useful in cases of hip dysplasia?

Hip arthroscopy (hip endoscopy) can be useful in cases of hip dysplasia if there are accompanying pathologies that need to be treated independently of the dysplasia. Examples include:

• Impingement : If CAM or pincer impingement is present in addition to dysplasia, excess bone material can be removed to improve mobility and relieve pain.
• Loose bodies in the joint : These can cause mechanical blockages in the joint and should be removed.
• Synovitis (inflammation of the joint lining) : Inflammation of the synovial membrane can be treated by arthroscopy.

Alternative treatment options for hip dysplasia

Since hip arthroscopy cannot correct the structural problems in dysplasia, other procedures are often more promising in the long term.

Periacetabular osteotomy (PAO)

In early stages of dysplasia, a periacetabular osteotomy can be performed. This surgically repositions the acetabulum to improve coverage of the femoral head. This stabilizes the joint and reduces stress on the labrum.

Short stem prosthesis

If advanced osteoarthritis is already present, a hip replacement is often the best option. A short-stem prosthesis is particularly suitable for younger patients. This preserves more bone structure than conventional prostheses and allows for easier revision surgery later on, should this become necessary.

Conclusion: Hip arthroscopy is often not suitable for hip dysplasia

Hip arthroscopy may be an effective solution for many hip problems, but it rarely shows lasting success in cases of hip dysplasia. The insufficient coverage of the femoral head persists, causing pain and instability to continue or even worsen. While associated pathologies such as impingement or loose bodies can be treated arthroscopically, the actual structural problems of dysplasia can only be permanently resolved through corrective osteotomies such as the PAO (periradicular osteotomy) or – in cases of advanced wear and tear – through hip replacement.

Anyone suffering from hip dysplasia should therefore seek comprehensive advice from a specialist in order to obtain the best possible treatment plan.