What is hip Arthroscopy?
Hip arthroscopy is another name for keyhole surgery of the hip. This allows hip surgery to be performed through 2-3 small incisions using a camera and specialised instruments. Arthroscopy can be used to treat some conditions that previously required larger open surgery.
What conditions can be treated with hip arthroscopy?
Several hip conditions can now be treated with arthroscopic surgery. The most common arthroscopic procedure is the treatment of a condition called femoro-acetabular impingement (FAI). Surgical treatment of FAI can involve multiple components:
Labral repair - Reattachment of the torn cartilge rim at the edge of the hip socket
CAM debridement - Removal of the extra bump of bone on the ball of the hip joint
Pincer debridement - Removal of a spur of bone at the edge of the hip socket
Capsular closure - Repair of the ligament surrounding the hip joint.
Other procedures which can be performed arthroscopically include: loose body removal, OS acetabulae removal, synovectomy, PSOAS tendon release, and treatment of traumatic cartilage loss (microfracture).
Hip arthroscopy is NOT helpful once there are signs of hip arthritis.
How is the surgery performed?
You require a general anaesthetic. The anaesthetist may also perform a nerve block to help minimise pain after surgery. Once you are asleep your foot is placed in a padded boot, and traction is applied to your leg to open up the hip joint. X-rays are used to locate the hip joint and the keyhole instruments are introduced through 2-3 small (1-2cm long) incisions. The inside of your hip joint can then be seen on a video screen to allow your surgeon to guide the instruments during surgery. X-rays are used during surgery to ensure only abnormal bone is removed. The labrum is repaired using small anchors to reattach it to the bone with strong stitches. The incisions are closed with 2-3 stiches in each. Surgery usually takes 2-3 hours.
What happens after surgery?
You will wake up in the recovery room, and be taken up to the ward once you are fully awake. Once you are feeling comfortable, you can get out of bed and walk with crutches. A physiotherapist will see you on the ward and teach you how to use the crutches. You should expect to stay one night in hospital and go home the next day.
You will have a large bandage on the front/side of your hip. This is to absorb any of the fluid used during the surgery which can sometimes leak out afterwards. The large bandage will be removed before you go home. Under the large bandage are small waterproof dressings, you can shower with these in place.
Your anaesthetist will prescribe strong pain relief to use during the first few days after the operation, some people may require this for longer. Once the initial pain settles you can use simple pain relief and anti-inflammatory medication.
What is the rehabilitation after hip arthroscopy?
Full recovery after hip arthroscopy surgery can take a long time. Patients often keep getting better for 12-18 months after their surgery. There are several key steps in the rehabilitation process:
The first six weeks post-surgery:
There are two main goals over the first six weeks; to allow your body to heal and to maintain hip motion. You will need to walk with crutches for 2-6 weeks. In the majority of cases you will be allowed to take weight on your leg during this time. You will need to do exercises to prevent your hip from becoming stiff and to minimise scar tissue formation. These exercises involve bending your hip up to 90 degrees, turning in and out (rotation), and moving your hip to the side (abduction). You should avoid deep bending, forceful twisting or stretching your hip behind you (hyperextension).
Six weeks to six months post-surgery:
Over this period, rehabilitation will focus on building muscle strength. The main muscles around your hip (abductors) can become weak after surgery. A physiotherapist can provide a specific exercise regime to help strengthen these muscles. If your physiotherapist requires more information on what exercises you should be doing, this can be provided for you. Regular use of a stationary bike is a good way to maintain your muscle strength and improve your hip flexibility.
Sports-specific rehabilitation can begin after three months. Depending on progress, you should be able to start light jogging at 12 weeks post-surgery. It may take 4-6 months or even longer to return to other sports, particularly contact sports. Full recovery may take 12-18 months.
Will surgery help the pain?
Pain around the hip can actually originate from different areas. Mr Gormack will examine your hip and assess your scans to help confirm that the pain is coming from your labral tear. If the cause of pain is unclear, an injection into the hip may be used to confirm that your pain is coming from your hip joint. In the majority of cases, successful treatment of your labral tear / FAI will result in improvement or relief of your pain.
What are the risks of surgery?
There are risks with any surgery. Problems after hip arthroscopy are uncommon but can happen. The main risks include:
Bleeding - This is usually minimal. There is a very small risk of bleeding from the artery and veins at the front of the hip joint.
Infection - The risk of infection after keyhole surgery is very low. The chance of a deep infection is less than 1 in 1000.
Nerve injury - Numbness in the thigh can occur. This generally improves with time. Numbness in the lower leg, foot or genitals and weakness of the leg muscles has been reported but is extremely rare.
Blood clots - Blood clots in the leg (DVT) or lung (PE) can occur after any lower limb surgery. You may be given blood thinning injections and stockings to wear after surgery to minimise your risk of blood clots. Please inform us if you have a known history of clots.
Fracture - A minimal amount of bone is removed during surgery. If you fall or have an accident during the first six weeks after surgery there is a risk of fracture. This is extremely unlikely.
Re-injury - The repaired labrum takes time to heal. If you do any heavy physical activity too early after surgery there is a risk that you can damage the repair.
Ongoing pain - Over 80% of patients experience improvement in pain and function after hip arthroscopy. Unfortunately, some patients will still have ongoing pain even after the mechanical problems in their hip have been fully corrected. Further surgery is usually not helpful in this situation.
When can I Drive after surgery?
Driving should only be considered once you are safe to respond rapidly in an emergency situation. This will depend on your specific circumstances and progress. In general, after surgery to the left hip you should be able to drive an automatic car after 1-2 weeks. After surgery to your right hip or if you drive a manual transmission car, driving is usually possible after 3-6 weeks. You should not drive if you are taking morphine-based pain relief.
When can I return to work?
Your ability to return to work will depend on a number of different factors. Mr Gormack will be able to provide you with individualised advice specific to your work situation and the physical requirements of your job. As a rough guide, office-based work is generally possible after 1-2 weeks. It may take 6-8 weeks to return to work that involves a lot of standing and walking (moderate physical activity). Returning to very heavy physical work may take three months or more.