An arthroscopy is a type of keyhole surgery used both to diagnose and treat problems with joints. It's most commonly used on the knees, ankles, shoulders, elbows, wrists and hips.
An arthroscopy involves the use of a device called an arthroscope to examine the joints. This is a thin, metal tube about the length and width of a drinking straw that contains a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece, so the surgeon is able to see inside the joint.
It's also possible for tiny surgical instruments to be used alongside an arthroscope to allow the surgeon to treat certain joint conditions
Proposed revisions to the eligibility criteria
Hip Arthroscopy procedures are categorised as Not Routinely Funded. This covers:
Sepsis of the hip joint (septic arthritis)
Washout of an infected native hip joint in patients with clear evidence of resistance to medical management, patients with underlying disease, patients who are immunosuppressed
Radiological proven loose bodies that are within the hip joint
Excision of radiological proven labral tears in the absence of osteoarthritis
Excision of radiological proven labral tears associated with an acute traumatic episode in the absence of osteoarthritis or FAI syndrome.
This means for patients requiring other additional hip arthroscopy procedures, the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need.
The CCG will only fund open or arthroscopic hip surgery for the treatment of femoro-acetabular if an Individual Funding Request proves exceptional clinical need.
Diagnosis of definite femoro-acetabular impingement defined by X-rays, MRI and CT scans.
Evidence that an orthopaedic surgeon has discussed each case with a specialist musculoskeletal radiologist.
Severe symptoms typical of FAI with duration of at least six months where diagnosis of FAI has been made with the diagnostic tests listed above.
Evidence of failure to respond to all available conservative treatment options including activity modification, pharmacological intervention and specialist physiotherapy.
Compromised function, which requires urgent treatment within a 6-8 month timeframe, or where failure to treat early is likely to significantly compromise surgical options at a future date.
Treatment with more established surgical procedures is not clinically viable.
The CCG will NOT fund hip arthroscopy in patients with femoro-acetabular impingement (FAI) where any of the following criteria apply:
Patients with advanced Osteo-Arthritic change on preoperative X-ray (Tonnis grade 2 or more) or severe cartilage injury (Outerbridge grade lll or lV).
Patients with a joint space on plain radiograph of the pelvis that is less than 2mm wide anywhere along the sourcil.
Patients who are a candidate for hip replacement.
Any patient with severe hip dysplasia or with a Crowe grading classification of 4.
Patients with generalised joint laxity especially in diseases connected with hypermobility of the joints, such as Marfan syndrome and Ehlers-Danlos syndrome.