What is Hip Arthroscopy?
Hip Arthroscopy is performed through small incisions (key hole surgery) using a camera to visualize the inside of a joint. Through several small incisions (usually 2-3, about 1 centimeter wide each), a camera is inserted into one incision, and small instruments through the other incisions.
Key hole hip arthroscopy is a highly specialised technique that it is much less invasive than traditional open surgery. It requires much experience and specialist fellowship training to perform properly.
Patients who have key-hole arthroscopic surgery rather than open surgery benefit from:
- Earlier rehabilitation
- Accelerated rehab course
- Smaller incisions
- Early return to sport
What conditions can be treated by Hip Arthroscopy?
Hip arthroscopy is great for visualising the hip joint and treating conditions such as
- Hip impingement. Femoroacetabular Impingement (FAI) is a disorder that can affect up to 25% of people. The hip joint is a ball and socket joint made up of the femoral head (ball) and the acetabulum (socket). When either the ball or socket is abnormally shaped, it can cause abnormal friction and movement, leading to pain, stiffness and arthritis. Hip impingement has been identified as a leading cause of hip arthritis.
- Labral tears. Around the socket (acetabulum), the rim is lined by special cartilage called the labrum. It acts like an O-ring found in taps or other plumbing. Labral tears are commonly found in association with hip impingement and hip dysplasia.
- Cartilage damage. Cartilage damage can be cleaned up, removed and “microfractured”, so that new types of cartilage can line your joint and help relieve the pain.
- Ligamentum teres tears. This ligament is a cord like structure which connects your ball to the socket. Tears of the ligamentum can be cleaned up, tightened using radiofrequency ablation and treated with cortisone.
How hip arthroscopy is performed
Hip arthroscopy can be done as a day procedure, but it is best when you stay overnight so that our nurses can take the best care of you.
During the hip arthroscopy, you are placed on your side and your foot is placed in a traction device so that space can be created in the hip joint.
Usually 2 – 3 incisions about 1 cm wide are made around the side of your hip. Special cameras and surgical instruments are passed through this incisions to perform your operation.
The procedure can last between 30 – 90 minutes, depending on what needs to be done.
Local anaesthetic is placed into your hip after the operation, so that you have as little pain as possible.
Severe hip inflammation seen on hip arthroscopy
There should be no floating objects in the hip. Floating cartilage fragments means that some part of the hip joint cartilage has been damaged
The hip labrum is torn
A normal ligamentum teres
After the Hip Arthroscopy
After the operation, you are cared for in the Theatre Recovery room.
Most people wake up fully when back in their rooms on the ward.
Whilst on the ward, the nurses will take care of your every need.
It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery.
The operation is usually less painful than expected as local anaesthetic is given throughout the operation, and pain relievers can be taken regularly after the operation.
The physiotherapist will visit you on the ward so teach you some exercises and help you use your crutches.
Recovery after Hip Arthroscopy
Most people can go home the next morning after surgery
It’s best to take at least 2 weeks off work to recover properly.
- Office work: 2 weeks
- Manual work: 6 weeks
A full regime of return to sport and work will be tailored to your needs by our physiotherapy team. In general:
- 4 weeks: stationary cycling
- 6 weeks: slow tread-mill until running.
We recommend seeing a physiotherapist who has been trained in pre-habilitation, recovery and rehabilitation after hip arthroscopy.
At the Specialist Orthopaedic Surgery Clinic, we run regular training sessions for Physiotherapists on Hip Arthroscopy Physiotherapy
Please ring us if you experience any of the following after your surgery
- Redness, swelling or warmth around the incisions
- Fever and chills.
- Any problems or concerns
Complications of Hip Arthroscopy
The rate of complications with hip arthroscopy is extremely low, but you must always weigh up the potential benefit to potential risk with every operation:
The risks and complications of Hip Arthroscopy include:
- Nerve injury. Nerve injury is very uncommon, but can be a significant problem.
- The most commonly affected nerves include
- the sciatic nerve
- the lateral femoral cutaneous nerve (sensation to the thigh),
- pudendal nerve (from the foot traction)
- Injury to any of the nerves can cause pain, lost of sensation, pins and needles, and other problems.
- Injuries to nerves are often temporary, but can be permanent
- The most commonly affected nerves include
- infection is a risk with every surgical procedure. With modern surgical technique and sterilisation, it is a rare but important risk to consider.
- Continued pain after the surgery.
- depending on your individual circumstance, complete relief of your pain and symptoms may not be achievable – especially with you have significant cartilage damage in your hip (osteoarthritis)
- It is important that you spend at least the first week after your surgery at home resting and letting your post-surgery inflammation settle
- This is best done with rest, ice and anti-inflammatories.
- The first 3 days after surgery are the most sore, and it’s important that you have someone at home to look after you
- it takes up to 12 months for the full results of hip arthroscopy, and most of the recovery is achieved in the first 3 months
- Your hip joint is surrounded by a tough membrane called the Capsule. As part of your body’s repair process after surgery, the capsule will form scar tissue to repair itself. Occasionally, the scar tissue will attach itself to labrum. This scarr tissue is called an adhesion.
What are the alternative treatments to having a Hip Arthroscopy?
Before any surgery is performed, you should always consider the non-operation alternatives.
When should I have my hip arthroscopy?
Ideally, within 6 months of developing your pain.
There has been recent research to show that patients who have their hip arthroscopy performed within 6 months of symptoms have better results than those whose symptoms have been present for more than 6 months.
How do I prepare for my hip arthroscopy?
Before your operation, your fitness for the operation will be assessed and all the necessary tests performed in preparation for the operation.
If you have any concerns, please contact us – we are here to help.
Tests that may be ordered for you include:
- Xray hip
- CT scan
Most patients don’t need blood tests or ECGs before hip arthroscopy surgery. Your Preadmission Form Health Questionnaire, will be assessed by the hospital nurses and your anaesthetist. If there are any concerns about your fitness for surgery, you will be contacted by our staff.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, please contact us for a program to improve your skin before surgery.
Get some help from your friends and family
Although you will be able to walk with crutches soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
The following is a list of home modifications that may make your return home easier during your recovery:
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
- A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
- A chair that can be placed in the shower
- A long-handled sponge and shower hose
What is the normal recovery like after a hip arthroscopy?
It is normal to feel some discomfort and perhaps some swelling in the groin, thigh, lower back and buttock regions. Occasionally patients have some numbness or tingling in the foot, leg, groin, or genitalia, which resolves.
When can I start walking?
Everyone is slightly different in their response to the surgery. The majority feel good enough to walk the next day, with crutches for support.
Can I change the dressing?
Yes. It is normal for the wounds to ooze some fluid. It is best that a trained nurse or doctor changes the dressing under sterile conditions to reduce the chance of infection.
When can I drive?
You shouldn’t drive in the first 48 hours after an anaesthetic. It is reasonable to drive when you have good movement and can walk and put weight on the leg.
When can I return to work?
This varies considerably with type of work, and details of procedure.
If your work involves mainly office works, then you can return to work after 1 – 2 weeks.
If your work involved heavy lifting or manual labour, you may need up to 4-6 weeks off work.
Further Reading and References
- Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy. Stone AV, Howse EA, Mannava S, Miller BA, Botros D, Stubbs AJ. Arthrosc Tech. 2017 Jun 5;6(3):e699-e704
Danish Hip Arthroscopy Registry (DHAR): the outcome of patients with femoroacetabular impingement (FAI). Lund B, Mygind-Klavsen B, Grønbech Nielsen T, Maagaard N, Kraemer O, Hölmich P, Winge S, Lind M. J Hip Preserv Surg. 2017 Apr 4;4(2):170-177
The current situation in hip arthroscopy. Marin-Peña O, Tey-Pons M, Perez-Carro L, Said HG, Sierra P, Dantas P, Villar RN. EFORT Open Rev. 2017 Apr 27;2(3):58-65
Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging. Buikstra JG, Fary C, Tran P.BMC Musculoskelet Disord. 2017 Mar 21