Hip Arthroscopy in Thessaloniki is a minimally invasive surgical method for the diagnosis and treatment of specific lesions within the joint. It is performed through small incisions and is considered when there is a clear cause of pain, significant functional limitation, and an inadequate response to conservative treatment.

The hip joint is subjected to significant loads during walking, work, and sports. For this reason, the success of treatment does not depend solely on the surgical technique. Proper diagnosis, careful patient selection, and an organized rehabilitation program are required.

Hip Arthroscopy in Thessaloniki is not a treatment for every form of hip pain. It is used for specific problems that have been confirmed by the medical history, clinical examination, and appropriate imaging studies.

Key Points

• Hip arthroscopy is performed through small incisions, using a special camera and fine surgical instruments.

• Common indications include femoroacetabular impingement (FAI), labral tear of the acetabulum, and the presence of loose bodies within the joint.

• A finding on MRI does not, by itself, mean that surgery is required.

• Physiotherapy and modification of aggravating activities often precede the surgical decision.

• Arthroscopy preserves the natural joint and is not the same as total arthroplasty.

• Advanced osteoarthritis can significantly limit the expected benefit.

• Postoperative rehabilitation is an integral part of treatment.

Table of Contents

1. What is hip arthroscopy?

2. Which conditions can it treat?

3. Which symptoms require evaluation?

4. How is the diagnosis made?

5. When is surgery considered?

6. How is arthroscopy performed?

7. Advantages and limitations

8. Rehabilitation

9. Possible risks

10. Frequently Asked Questions

What Is Hip Arthroscopy?

Hip arthroscopy is a surgical technique in which a small camera, the arthroscope, is inserted into the joint.

The image is transmitted to a high-definition monitor. The surgeon can thus examine the labrum, the articular cartilage, the femoral head, and the acetabulum.

Through additional small incisions, special instruments are inserted. With these, different corrective procedures can be performed, depending on the problem identified.

The American Academy of Orthopaedic Surgeons describes hip arthroscopy as a method that allows the examination and treatment of problems within the joint without the large incision of open surgery.

Hip Arthroscopy is considered minimally invasive because of the small size of the surgical access points.

This does not mean that it is a simple procedure. The hip is a deep and complex joint, and the technique requires specialized training and experience.

Which Conditions Can It Treat?

The suitability of arthroscopy depends on the type of lesion, the condition of the cartilage, and the correlation of the findings with the actual symptoms.

Conditions and Possible Arthroscopic Treatment

The table presents indicative possibilities. It does not mean that every patient with one of the above problems requires surgery.

Femoroacetabular Impingement

Femoroacetabular impingement occurs when the shape of the femoral head, the acetabulum, or both causes pathological contact during movement.

The main morphological types are:

• cam type,

• pincer type,

• mixed type.

Repeated contact can place stress on the labrum and the articular cartilage.

The official information from the Royal National Orthopaedic Hospital of the NHS states that the diagnosis of femoroacetabular impingement syndrome is based on the combination of symptoms, clinical signs, and imaging findings.

The presence of cam or pincer morphology without symptoms is not, by itself, an indication for treatment.

More information is provided in the article Hip and groin pain: when can femoroacetabular impingement be the cause.

Labral tear

The labrum is a strong fibrocartilaginous ring that surrounds the acetabulum.

It contributes to the stability and smooth function of the joint. Damage to it can cause pain, clicking, stiffness, or a feeling of catching.

Hip Arthroscopy in Thessaloniki may, in appropriately selected cases, be used to repair or stabilize the labrum.

For more details, read the article Hip labral tear: symptoms and arthroscopic treatment.

Clicking, catching, and loose bodies

An occasional, painless click does not necessarily mean that there is a serious injury.

However, when clicking is accompanied by pain, locking, loss of motion, or a feeling that the joint is “sticking,” orthopaedic evaluation is needed.

Loose fragments of cartilage or bone may move within the joint and cause mechanical symptoms.

Related information is available in the article Clicking or locking in the hip: when evaluation is needed.

Articular cartilage injuries

Articular cartilage covers the bony surfaces and allows smooth movement of the joint.

Limited, focal injuries differ significantly from the extensive wear of advanced osteoarthritis.

In selected cases, the surgeon may address unstable or damaged cartilage areas arthroscopically.

Suitability depends on:

• the size of the injury,

• its depth,

• its location,

• the quality of the remaining cartilage,

• the patient's age and demands,

• the presence of other anatomical problems.

For more information, read the article Cartilage injuries in the hip: when can they be treated arthroscopically.

Which symptoms require evaluation?

The most common symptom of an intra-articular injury is groin pain.

Pain may appear or worsen during:

• deep hip flexion,

• prolonged sitting,

• getting in and out of a car,

• deep squatting,

• running,

• sudden changes of direction,

• sports activities.

Other possible symptoms are:

• stiffness,

• reduced range of motion,

• painful clicking,

• a feeling of catching,

• pain after exercise,

• difficulty with stairs,

• difficulty putting on shoes or socks.

NICE states that femoroacetabular impingement may be associated with pain, clicking, and restricted movement, while symptoms often worsen with hip flexion or prolonged sitting.

These symptoms alone do not prove that Hip Arthroscopy in Thessaloniki is needed.

Pain may also originate from other areas, such as the tendons, muscles, the greater trochanter, the lumbar spine, or the sciatic nerve.

Lateral hip pain

Pain on the outer side of the hip usually does not originate from the labrum.

It may be related to:

• trochanteric bursitis,

• abductor tendinopathy,

• iliotibial band irritation,

• greater trochanteric pain syndrome.

Related information is provided in the article Biologic factors versus surgical treatment in persistent trochanteric bursitis.

Buttock pain

Buttock pain may originate from the hip, but it may also be related to the lumbar spine, the sciatic nerve, or the deep gluteal muscles.

When the pain extends to the back of the thigh or leg, it is important to investigate whether it is sciatica or another neurological cause.

Piriformis syndrome is one possibility, but it should not be assumed without examination.

Read more about the orthopaedic examination and pain evaluation.

How is the diagnosis made?

The diagnosis is based on three main elements:

1. the patient's history,

2. the clinical examination,

3. appropriate imaging studies.

The orthopaedic surgeon examines when the pain appears, which movements trigger it, and how much it affects work, walking, or sports.

During the clinical examination, the following are assessed:

• range of motion,

• muscle strength,

• stability,

• gait,

• the location of tenderness,

• reproduction of symptoms with specific maneuvers.

No single clinical test is sufficient to decide on surgery.

Imaging studies may include:

• plain X-rays,

• special radiographic views,

• magnetic resonance imaging,

• magnetic arthrography in selected cases,

• computed tomography for detailed assessment of bone morphology,

• diagnostic injection into the joint.

What is assessed before surgery?

The presence of a morphological abnormality does not prove that it is the cause of the pain.

Hip Arthroscopy should be considered when there is a clear correlation between symptoms, clinical findings, and imaging results.

When is the procedure considered?

Before a surgical decision is made, individualized conservative treatment is usually applied.

This may include:

• modification of aggravating activities,

• specialized physiotherapy,

• strengthening of the muscles around the hip,

• improvement of pelvic control,

• appropriate analgesic or anti-inflammatory treatment,

• selected diagnostic or therapeutic injections.

Hip Arthroscopy may be considered when:

1. the pain is persistent,

2. function is significantly limited,

3. there is a clear intra-articular lesion,

4. the findings are consistent with the symptoms,

5. conservative treatment has not been sufficiently effective,

6. there is no advanced degenerative destruction,

7. the patient can follow the rehabilitation program.

AAOS states that arthroscopy may be recommended when a painful condition does not respond adequately to non-surgical treatments, such as physiotherapy, activity modification, and appropriate medication.

Age is not the only criterion. Greater importance may be attached to:

• the condition of the cartilage,

• the degree of osteoarthritis,

• the morphology of the joint,

• the presence of instability or dysplasia,

• the patient's functional needs.

When may it not be an appropriate option?

Arthroscopy is not a solution for every patient.

Advanced osteoarthritis, extensive cartilage loss, and significant narrowing of the joint space may limit the expected benefit.

Special evaluation is needed when there is:

• hip dysplasia,

• instability,

• osteonecrosis,

• extensive cartilage damage,

• severe deformity,

• pain that originates mainly from the spine,

• advanced degenerative arthritis.

The NICE guidance states that patients with advanced osteoarthritic degeneration may require total arthroplasty instead of arthroscopic treatment.

Aseptic necrosis of the femoral head

Aseptic necrosis is caused by impaired blood supply to the femoral head.

Treatment depends mainly on the stage of the condition and on whether collapse of the femoral head has already occurred.

In early stages, joint-preserving procedures may be considered. In advanced stages, arthroplasty may be required.

Arthroscopy alone is not the primary treatment for aseptic necrosis, but it may be used as an adjunct in highly selected cases.

More information about joint replacement is provided on the Total Hip Arthroplasty page.

Arthroscopy and total hip arthroplasty

The two procedures have different indications and are not alternatives for every patient.

How is arthroscopy performed?

The procedure is usually performed under general anesthesia, although the final choice is made by the surgical and anesthesiology team.

The lower limb is placed under controlled traction so that the necessary space within the joint is created.

The surgeon creates small entry portals for the camera and instruments.

First, the intra-articular structures are examined. The necessary corrections are then performed.

Depending on the diagnosis, Hip Arthroscopy in Thessaloniki may include:

• repair of the labrum,

• removal of a cam-type bony prominence,

• selected correction of the acetabulum,

• removal of loose bodies,

• treatment of unstable cartilage,

• removal of pathological synovium,

• management of the joint capsule.

AAOS states that procedures such as labral repair, removal of bony prominences, and treatment of damaged cartilage can be performed through arthroscopy.

NICE also describes the use of traction, an arthroscope, and special instruments for the removal of pathological bone or cartilage tissue.

The exact duration of the procedure depends on the number and complexity of the lesions.

What are the advantages and limitations?

A key advantage is the ability to access the joint through small incisions.

The technique provides a detailed view of the intra-articular structures and may allow more than one lesion to be treated in the same procedure.

Possible advantages include:

• small surgical incisions,

• limited soft tissue approach,

• direct visual examination of the joint,

• ability to repair the labrum,

• ability to correct selected bony abnormalities,

• preservation of the natural joint.

Hip Arthroscopy does not guarantee complete pain relief. The outcome depends on:

• the correct diagnosis,

• the condition of the articular cartilage,

• the extent of the lesion,

• the surgical technique,

• age and functional needs,

• adherence to rehabilitation.

The multicenter randomized study UK FASHIoN compared arthroscopy with an individualized conservative treatment program in selected patients with femoroacetabular impingement (FAI).

Both groups improved, while the arthroscopy group showed a greater mean improvement in hip-related quality of life at 12 months.

A second randomized clinical study showed better functional outcome after arthroscopy compared with physiotherapy and activity modification in selected patients.

These results do not mean that every patient with impingement should undergo surgery. The studies concern individuals who met specific selection criteria.

Rehabilitation after Hip Arthroscopy

Rehabilitation begins from the first postoperative days.

The program varies depending on the surgical procedures. Different protection may be required after labral repair and different protection after simple removal of a loose body.

In the early stages, crutches and weight-bearing restrictions may be needed.

AAOS states that the duration of use of walking aids depends on the extent of the procedure and that physiotherapy is usually necessary to improve strength and mobility.

Frimley Health NHS Foundation Trust also provides structured guidance on mobilization and the first exercises after hip arthroscopy.

Key stages of rehabilitation

The stages do not correspond to a common and mandatory timeline for everyone.

Return to driving, work, or sport depends on:

• the type of lesion,

• the surgical procedures,

• pain,

• the quality of walking,

• muscle strength,

• the type of work,

• the demands of the sport.

What are the possible risks?

As with any surgical procedure, Hip Arthroscopy in Thessaloniki is associated with potential risks.

These may include:

• infection,

• hematoma or bleeding,

• thrombosis,

• nerve or vessel injury,

• temporary numbness due to traction,

• stiffness,

• adhesions,

• heterotopic ossification,

• persistence of some symptoms,

• need for another procedure.

AAOS lists possible risks as nerve or vessel injury, temporary numbness associated with traction, infection, and venous thrombosis.

NICE recognizes that known complications exist and recommends that the procedure be performed with appropriate processes of informed consent, clinical governance, and outcome recording.

The preoperative discussion should include:

• the expected benefits,

• the specific risks,

• the alternative options,

• the possibility of persistent symptoms,

• the rehabilitation program.

Why is the surgeon’s specialization important?

Hip arthroscopy has increased technical demands.

The joint is located deep, is adjacent to nerves and vessels, and requires precise understanding of three-dimensional anatomy.

The decision for Hip Arthroscopy in Thessaloniki should be based on:

• the surgeon’s experience,

• specialization in hip preservation surgery,

• comprehensive preoperative assessment,

• organized postoperative follow-up,

• collaboration with a specialized physiotherapist.

NICE recommends that arthroscopic surgery for femoroacetabular impingement be performed by surgeons with special experience in arthroscopic hip surgery.

During the preoperative visit, it is useful to discuss:

• the exact diagnosis,

• the non-surgical options,

• the condition of the cartilage,

• the technique recommended,

• the possible risks,

• the weight-bearing program,

• the duration of rehabilitation,

• the criteria for returning to work or sport,

• the realistic chances of improvement.

Specialized hip assessment in Thessaloniki and Athens – Patients from Cyprus

Dr Alexandros P. Tzaveas, Orthopaedic Surgeon – PhD in Medicine, with specialization in arthroscopic hip surgery, provides specialized hip assessment in Thessaloniki and Athens. In Thessaloniki, he sees patients at the Private Office, 23 Agias Sofias, at the Interbalkan Medical Center, 10 Asklipiou, Pylaia, as well as at Kyanous Stavros, 1 Vizantos Vizyiis. In Athens, he sees patients by appointment at Mediterraneo Hospital, 8–12 Ilias, Glyfada.

The possibility of assessment in both Athens and Thessaloniki allows patients with femoroacetabular impingement (FAI), labral tear, or other intra-articular lesions to be evaluated by specialists before deciding whether hip arthroscopy is the appropriate treatment option.

Dr Tzaveas also sees patients from Cyprus seeking specialized assessment for hip conditions. Where appropriate, communication or video consultation may take place first, so that further assessment in Greece can be organized. If, after the necessary evaluation, there is an indication for surgical treatment, hip arthroscopy and the related medical and surgical care are performed in Greece.

Conclusion

Hip Arthroscopy in Thessaloniki is a modern and minimally invasive option for treating specific joint lesions.

It may be used for femoroacetabular impingement, labral tear, loose bodies, and selected cartilage lesions.

The decision should not be based on a single MRI finding alone.

A clear diagnosis, failure of appropriate conservative treatment, and a realistic assessment of the potential benefit are required.

Advanced osteoarthritis and extensive cartilage wear may significantly limit the results.

The surgeon’s specialization and organized rehabilitation are key prerequisites for the safe application of the treatment.

Sources

1. American Academy of Orthopaedic Surgeons – Hip Arthroscopy

2. NICE – Arthroscopic femoro-acetabular surgery for hip impingement syndrome

3. Royal National Orthopaedic Hospital NHS – Femoroacetabular Impingement Syndrome

4. Frimley Health NHS Foundation Trust – Hip Arthroscopy

5. UK FASHIoN Randomized Controlled Trial

6. Arthroscopy versus physiotherapy randomized trial