What is hip arthroscopy?
Hip arthroscopy is a key hole surgery that rapidly evolved in the last twenty years. A fibreoptic telescope is inserted into the hip and the joint is evaluated. The cause for pain is identified and commonly can be treated.
It is like very commonly performed knee and shoulder arthroscopy. However it is less commonly performed. Hip is a much deeper situated joint than others and is surrounded by strongest muscle and ligaments in the body. This makes hip arthroscopy quite challenging.
Do I need a hip arthroscopy?
The decision to go ahead with hip arthroscopy is a decision to be taken after a good discussion with the surgeon. Pros and cons of non operative and operative treatment will be discussed before deciding to go ahead with hip arthroscopy. It is performed commonly for removal loose body, treatment of hip impingement, labral repair etc. Sometimes it is performed for assessment of painful hip (diagnostic).
How is it done?
The procedure is commonly performed under general anaesthesia. It can be done under spinal anaesthesia as well. Patient is safely positioned on the operating table. Special equipment is needed to stabilise the pelvis and apply traction to the leg being operated to open up the hip joint. Two or three incisions (1-1.5cm in length) made around outer aspect of the hip. The instruments are passed into the hip joint under Image intensifier (X ray) control. After assessing the joint the treatment is carried out. The duration varies depending on the type of procedure and severity of the condition.
What is the aim of this surgery?
Painful arthritis is a debilitating condition that can severely affect our lives, both physically and mentally. When other non-operative measures have been exhausted, such as lifestyle alterations, physiotherapy and painkillers then hip replacement is an excellent pain relieving option. The aim of this surgery is to replace the worn areas of the hip joint. This relieves pain, restores function and aims to return you to an active lifestyle.
Who might benefit from this procedure?
Surgery is considered once non-operative measures for hip osteoarthritis have been tried and your symptoms continue to affect your everyday activities and often your sleep. Because of the inherent risks of surgery* (see section below) it is often a question of when the benefits of surgery outweigh these risks.
What does the procedure involve?
You will come into hospital on the morning of surgery and be admitted by the ward staff. Please remember to bring with you the BOA consent form which will have been provided by our Invicta office team – these can also be downloaded here. Both the anaesthetist and your surgeon will meet with you and go over any questions or concerns you have.
The operation itself takes approximately 1 hour. You will have approximately a 10cm incision over your hip in the region of your buttock. After the operation is completed you will go to recovery before arriving back on the ward. The legs will feel numb and weak for few hours until the spinal anaesthesia wears off. It is usually safe to fully weight-bear on your new hip straightaway. This should only be done with the physiotherapy or nursing team at first.
What happens after surgery?
The patients can go home on the same day if safe. Sometimes they stay overnight. The patients can start mobilising straight after the surgery with help of crutches. Protected weight bearing will be for 7 to 14 days depending on the type of procedure. Stitches might have to be taken out after day 10. Patients can start driving after one or two weeks depending on the procedure. Return to work depends on the nature of work, type of procedure and recovery.
What exercises will be given?
After the surgery the patients will be seen by the physiotherapist. The level of physiotherapy depends on the type of procedure. The first 2 – 6 weeks the main focus will be regaining range of movements in the hip, gentle strengthening exercises, balancing exercises and gait training. Range of movements in flexion and abduction will be restricted for few weeks in patients with labral repair. Once the wound has healed water based exercises can be commenced which are very helpful. Around six weeks time low impact exercises can be started gradually increasing endurance and strength. As and when the exercises are increased there is likely to be some discomfort in the hip. After 12 weeks high impact exercises and gradual return to sports activities can be started. It can take between 3-9 months before the benefits become more appreciable.
What are the possible complications?
There are possible complications like infection, deep vein thrombosis and pulmonary embolism. However these are very rare. Damage to blood vessels and nerves are very rare. There might be numbness in the perineal area but is very rare and usually recovers in few days to couple of weeks. General complications related to heart, lungs etc are extremely rare.