Acetabuloplasty

What is Acetabuloplasty?

An acetabuloplasty is a surgical procedure employed for the correction of a condition known as pincer impingement.

Pincer impingement is a form of hip impingement, also known as femoroacetabular impingement (FAI).

Femoroacetabular impingement is a condition characterized by excessive friction in the hip joint from the presence of bony irregularities. The femoral head and acetabulum rub against each other, causing damage and pain to the hip joint, as well as decreased range of motion. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket). The articular cartilage or labral tissue can fray or tear after repeated friction.

Pincer impingement involves the acetabular side of the hip joint and occurs when the socket or acetabulum rim has overgrown and covers too much of the femoral head, resulting in the labral cartilage being pinched. Pincer impingement may also occur when the hip socket is abnormally angled backward, causing an abnormal impact between the femoral head and the rim of the acetabulum.

The acetabuloplasty procedure involves trimming the pincer lesion or over-coverage with a burr and reshaping the acetabulum to restore normal pain-free hip movement.

Anatomy of the Hip Joint

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. Stability of the hip joint is achieved by the labrum, ligaments, and tendons that encase the hips and support their movement.

Indications for Acetabuloplasty

Acetabuloplasty is indicated when conservative treatment such as medications, physical therapy, injections, rest and activity modifications have failed to resolve symptoms associated with pincer impingement such as:

• Pain, which may be a dull ache or a sharp pain
• Groin pain associated with hip activity
• Complaints of pain in the front, side or back of the hip
• A locking, clicking, or catching sensation in the hip
• Pain in the inner hip or groin area after prolonged sitting or walking
• Difficulty walking uphill
• Restricted hip movement
• Lower back pain
• Pain in the buttocks or outer thigh area

Preparation for Acetabuloplasty

Preoperative preparation for acetabuloplasty generally involves the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You may need to refrain from supplements or medications such as blood-thinners or anti-inflammatories a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a week before surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Acetabuloplasty

Acetabuloplasty is usually performed as a minimally invasive technique called hip arthroscopy under regional or general anesthesia. Hip arthroscopy, also referred to as keyhole surgery, is a surgical procedure in which an arthroscope, a narrow tube with a tiny camera and light source on the end, is used to assess and repair damage at the hip joint.

During acetabuloplasty, your surgeon will make 2 or 3 small incisions about 1/4 inch in length around the hip joint. Through one of the incisions, the arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work. The camera attached to the arthroscope displays the image of the joint on the monitor. The larger image on the television monitor allows your surgeon to visualize the joint easily to determine the extent of damage. Miniature surgical instruments are inserted through other tiny incisions to trim the sections of over-coverage on the acetabular side to alleviate bony impingement and create space to enable normal hip motion. Tissue damage such as labral tearing is also typically addressed during the procedure. After completion of the procedure, the arthroscope and instruments are removed, and the incisions are closed and covered with a bandage.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after acetabuloplasty will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Acetabuloplasty is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Thromboembolism or blood clots
• Dislocations (rarely)
• Anesthetic/allergic reactions