What is hip arthroscopy?
Hip arthroscopy (keyhole surgery) is a surgical procedure where a small camera is placed into the hip joint. Through additional small incisions, instruments can be inserted into the joint to repair or remove tissue.
Conditions when hip arthroscopy may be performed?
Hip arthroscopy is used to treat a number of conditions in and around the hip joint including:
Femoroacetabular impingement (FAI)
The most common reason hip arthroscopy is performed is to address the cause of hip impingement and repair or remove the damaged tissue that this has led to. This can include removing excess bone and repairing the labrum.
Labral tears
Labral tears are common and do not necessarily causes people a problem. It is important to understand why the labrum has torn and address the cause. Labral tears can be repaired or removed if the tissue can not be stitched.
Articular cartilage damage
If the lining of the joint is damaged due to injury or impingement a procedure called microfracture can be performed to help create a patch of scar tissue to cover the damaged area.
Ligamentum teres (LT) Tears
LT tears can occur in patients with FAI, but can also occur due to trauma and hyper mobility. This is a difficult condition to diagnose as LT tears are not necessarily pparent on MRI scans.
Capsule plication (tightening)
This is a procedure that can be performed in patients with excessive rotation in the hips. This is usually performed in patients with LT tears and associated hyper mobility to help reduce the risk of suffering another LT tear.
Loose bodies
Sometimes loose bits of bone or calcified soft tissue can form in the hip joint which can be removed.
How do I know if hip arthroscopy is right for me?
The most important thing is to ensure that you have the most accurate diagnosis possible. Athorough understanding of your hip symptoms, specific findings during physical examination and interpretation of x-rays and scans is essential.
Once a diagnosis is made and if you have not improved with physiotherapy, then arthroscopy can be considered. It is important to discuss and understand the risks and expectations of recovery.
What are the other treatment options?
Non-surgical treatment
A focussed rehabilitation programme under the care of an experienced therapist can provide symptom relief. All patients should participate in a rehabilitation programme in the first instance.
Injections can be used to help reduce symptoms in the short term. Some patients can use this short term relief to rehabilitate and manage their symptoms after the affects of the injection have worn off.
Surgical treatment
It is possible to treat the above conditions using open surgery through large incisions.
How to decide on treatment?
Deciding what treatment is best for you can be difficult and will require a discussion with Mr Webb and/or your therapist. Mr Webb always tries to improve the mechanics of the hip and restore functional anatomy. Factors to take into account are:
- The duration of symptoms
- Response to rehabilitation
- Activity and lifestyle changes
- Expectations.
What does surgery involve?
Hip arthroscopy is usually performed under general anaesthetic. You are placed on your side and your foot is placed in a plastic boot.
Sometimes a post is placed between your legs and traction is applied to the boot. A small camera is placed into the hip and is used to look around the entire hip and then address any other problems that may be present. The procedure can usually takes one to two hours.
What are the risks of surgery?
It is important to discuss the risks to ensure that you can assess whether surgery is right for you.
The specific risks for hip arthroscopy surgery include:
- INFECTION — this risk of infection is less than 1 in 1000 cases. A single dose of antibiotic given during the anaesthetic.
- BLOOD CLOTS — the risk of developing a blood clot is approximately 1 in 1000. Clots in the leg (Deep Vein Thrombosis/DVT) can travel to the lung (Pulmonary Embolus/PE).
- PAIN — people can experience pain following surgery. This is mainly dictated by the degree of damage within the hip.
- STIFFNESS — It is important to follow a rehabilitation programme.
- FRACTURE — When bone is removed this creates a theoretical weakness in the bone that could lead to it breaking. It is important not to jump/run for 6 weeks after the procedure.
- NERVE INJURY — 1 in 100 people have an injury to either the nerve that supplies the foot and ankle or the inner thigh. The vast majority of these resolve within the first 24 hours following surgery.
Click to watch an animation of a labral repair
What happens before surgery?
Consent
It is important that you understand the potential risks or surgery as well as the benefits. You will have the opportunity to go through these with Mr Webb. Prior to the procedure, an electronic consent form will be sent to you that goes through the risks in detail. Please do not hesitate to arrange an appointment to discuss any questions you have.
Prehabilitation
Mr Webb advises that you start a physiotherapy programme prior to surgery.
The aims of prehabilitation are:
- Muscle strength and hip control
- Practice using crutches
What happens on the day of surgery?
You will be asked to come to hospital where one of the nursing staff will prepare you for the procedure. The anaesthetist will meet you to discuss the type of anaesthetic and pain relief plan for after. Mr Webb will confirm the details of the procedure with you, answer any last-minute questions and draw an arrow on your leg.
The procedure normally takes 1 to 2 hours. Once you have recovered from the anaesthetic, you will get up with your crutches and practice walking. The vast majority of patients go home a few hours after their operation.
Immediate Post Operative Plan
You will be given a set of crutches. You should use the crutches until you can walk normally. Avoid walking with a limp. Most people will no longer need crutches after the first two weeks.
You should not do any activities with impact. This means no running, jumping, sports for the first 6 weeks. This is to reduce the risk of fracture.
What happens after surgery?
Mr Webb will review you after surgery. It is common not to remember the details of this due to the anaesthetic, but the details of the procedure will be discussed at follow-up and can be sent to your physiotherapist if requested by yourself.
It is normal to have pain and swelling following a hip arthroscopy. This varies from patient to patient and can be localised to the hip, but can affect the whole thigh and knee. There are cold therapy machines available to help reduce the swelling. It is a good idea to see your physiotherapist within the first week following your operation.
As mentioned above, one of the risks of the procedure is nerve injury. It is normal to have some numbness and this usually improves within the first couple of weeks.
At approximately two weeks, you will be seen by Mr Webb to review the incisions and go through the details of what was found and performed.
Dressings and wound care
The sticky dressings should remain on until the two week review, even if blood stained. It is common that the dressings can soak as the fluid used during the procedure leaks. This sometimes means the dressings come off. If they do, they can replaced by any simple waterproof dressing.
If the waterproof dressings are intact you can shower, but do not soak the dressings and be careful not to slip or put too much weight through the operated leg.
After your two week review, you can have a bath, swim and start hydrotherapy.
Mobility
You are likely to require crutches for approximately two weeks. You can come off the crutches once you can walk without a limp.
Rehabilitation
This is a very important part of recovery. Each patient is different and requires individualised rehabilitation. Mr Webb is happy to discuss your hip and operation with your therapist if you give permission. As a baseline guide, Mr Webb recommends following the Takla-O’Donnell Protocol developed at Hip Arthroscopy Australia.
