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Hip Arthroscopy

Other popular names

What is it?

An Arthroscopy has been for a time the gold standard for Knee surgery and is now being increasingly used both for surgery in and around Hip.  It is also effective as a day case treatment of most conditions around the young adult hip and the elite sportsman.

The Arthroscopy itself is a surgical procedure that gives your consultant a clear view of the inside of a joint. This helps them diagnose and treat joint problems.  During hip arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.

Within the discipline of sports medicine, the hip has received considerably less attention than other joints, largely because of the difficulty that practitioners have traditionally had in assessing intra articular abnormalities around the hip. Over the past few years, hip arthroscopy has been gaining considerable interest. The advent of better diagnostic tools, especially MRI, has helped in the detection of hip Labral tears in a more predictable fashion. New techniques and instrumentation have facilitated the treatment of Labral tears by hip arthroscopy. Most notably, the recent adaptation of arthroscopy instruments specifically designed for the hip has led to improved safety, visualization, and accessibility of this joint.

You may be recommended for hip arthroscopy if you have a painful condition that does not respond to nonsurgical treatment.  Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body's normal reactions to injury or disease. In an injured or diseased hip joint, inflammation causes swelling, pain, and stiffness.

Hip arthroscopy may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. Although this damage can result from an injury, other orthopaedic conditions can lead to these problems, such as:

Surgical treatment

At the start of the procedure, your leg will be put in traction. This means that your hip will be pulled away from the socket enough for your consultant to insert instruments, see the entire joint, and perform the treatments needed.

After traction is applied, your surgeon will make a small puncture in your hip (about the size of a buttonhole) for the arthroscope. Through the arthroscope, he or she can view the inside of your hip and identify damage.

Other instruments will be inserted through separate incisions to treat the problem.  A range of procedures can be done, depending on your needs. For example:

The length of the procedure will depend on what is found during the diagnostic evaluation and the amount of work to be done.  Typically this will be 15-30 minutes.

Post-surgery rehabilitation

Most patients are able to return home on the same day as surgery. They can often be discharged several hours after surgery as long as they are sufficiently recovered from the anaesthetic, although some patients take longer to recover. Most patients are pain free when discharged.  All patients will need someone to take them home and be with them on the night following surgery.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The large bandage around the hip is normally removed 24-48 hours after surgery.  The non-stick sterile dressings on the wound are replaced with clean waterproof.

Return to normal routine

Bathing and showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 4 to 5 days after surgery.
In summary, whilst the wounds are wet - keep them dry and when the wounds are dry, you can get them wet.

Rehabilitation

Patients should and try to minimize their activities as much as possible in the first few days following surgery. The leg should be rested and elevated as much as possible. Painkillers (supplied on discharge from hospital) and cold packs may be used as required.

Simple exercises, including straight leg raises and other exercises as instructed by your physiotherapist prior to discharge should be performed.

Most patients do not require formal physiotherapy following arthroscopy as all patients are seen and assessed by a physiotherapist prior to discharge from hospital.

Some patients might require physiotherapy either before or after the first post-operative check-up.

Return to activity

Recovery is a gradual process and whilst most patients bounce back quickly following arthroscopy everyone should assume it will take up to 6 weeks to make a full recovery and symptoms can often improve for some time beyond this period.

The speed of recovery depends on the surgery performed, the degree of degeneration found and the age of the patient.

In general, the older the patient and the more degeneration a patient has, the slower and less predictable recovery will be.  Most patients can perform most tasks around the house and return to driving within a few days. Sedentary/office workers can often return to work a few days after surgery.  Patients performing more physical work might require two to 6 weeks off work depending on their individual positions.  Patients can usually return to sport between 3 to 6 weeks following surgery.

The small wounds can remain tender for a few months following surgery.

Return to driving:

The leg needs to have full control of the pedals.  You are advised to avoid driving for at least 7 days or you regain full use of your leg.

Risks

Potential complications include infection, injury to blood vessels and nerves and severe pain and swelling in addition to the rare general complications such as blood clots (DVT) and anaesthetic risks.

In general, the risk of sustaining a complication as a consequence of the operation that leaves you worse off in the long term is less than 1%.

An Arthroscopy is an extremely safe routine operation with a very low complication rate.  Overall over 97% are happy with the result. However complications can occur.   Any surgery in the hip joint carries a small risk of injury to the surrounding nerves or vessels, or the joint itself. The traction needed for the procedure can stretch nerves and cause numbness, but this is usually temporary.

There are also small risks of infection, as well as blood clots forming in the legs (deep vein thrombosis).

Many people return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your hip.

For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). These are decisions you will make with the guidance of your surgeon.

Sometimes, the damage can be severe enough that it cannot be completely reversed and the procedure may not be successful.

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