The role of hip arthroscopy in the treatment of synovial disorders and loose bodies

Arthroscopic surgery of the hip is an evolving procedure that can facilitate the diagnosis and treatment of synovial-based disease. Radiographic studies have not reproducibly identified many of the synovial conditions that can affect the hip, and arthroscopy has provided a means to improved diagnostic accuracy and the ability to treat certain conditions. Arthroscopic intervention has been reported in synovial chondromatosis and osteochondromatosis, pigmented villonodular synovitis, inflammatory arthropathies including rheumatoid arthritis, and acute septic arthritis. Patients with other conditions that result in acute and chronic synovitis within the hip such as hemosiderotic synovitis secondary to hemophilia and chondrocalcinosis also may benefit from arthroscopic intervention. These synovial and intraarticular abnormalities have been associated with accelerated joint degeneration, and although the pathologic mechanisms have not been delineated clearly, the clinical description has been advanced using hip arthroscopy. Increased awareness of the association between synovial abnormalities and degeneration has resulted from arthroscopy applied to the hip in early stages of disease and early in the course of symptomatic dysfunction. The indications and treatment capabilities will continue to expand with additional understanding of early hip disease, improvements in equipment, and as outcome studies reveal that the patient benefits from the procedure.