Hip Arthroscopy
Posted on Thu, Jan 13, 2011 @ 06:49 AM
Hip arthroscopy is perhaps the most significant advance in sports medicine over the past several years. Currently there are many reasons why a surgeon might recommend hip arthroscopy to a patient. Some of these reasons are as follows:
- Correction of femoroacetabular impingement (FAI)
- Removal or repair of a torn acetabular labrum
- Removal of loose or foreign bodies
- Repair of damaged articular cartilage
- Management of hip joint infection
- Inflammation of the hip lining (synovitis)
- To explain unexplained hip pain (diagnostic hip arthroscopy)
How we perform hip arthroscopy:
Hip arthroscopy is typically performed as an outpatient procedure. The bones of the hip joint (the ball and socket) are separated by approximately 1cm by applying traction to the foot while wearing a special boot. By distracting the hip, this provides enough room for the scope and instruments to be introduced into the joint. Generally, two or three quarter-inch incisions are used.
Through these small holes, the arthroscope and instruments are passed into the joint. The surgeon will then be able to visualize the hip joint, identify the problem(s), and proceed appropriately. The duration of the procedure will vary depending on the problem in the hip joint but can last from 30 minutes to 120 minutes, or even more. During the surgery, further x-rays may be taken, for example, to confirm adequate removal of bone. At the end of the procedure, medications may be injected into the hip to minimize pain after the surgery. The small holes are often closed with absorbable sutures. Finally, a dressing is placed over the holes.
After hip arthroscopy:
Usually, you will feel some discomfort in your hip. In addition, the discomfort can be experienced in the lower back, buttock, knee and ankle. The discomfort can normally be reduced with the appropriate pain relieving medications. Many patients report mild swelling in the groin, buttock and thigh. This is caused by the fluid used during the surgery. The swelling goes down within a few days. Observe the wound for any signs of infection (increasing pain, redness or swelling). The skin incisions can sometimes leak fluid or blood slightly for a few days; this is normal.
You are likely to be seen by a physical therapist following your surgery. They will advise you on how to progress your activity based on instructions received from your surgeon. You may require crutches for a few days or weeks depending on what specific surgery has been performed.
Your surgeon and physical therapist will develop an appropriate rehabilitation program for you following the surgery. This will include your return to sporting activities (running etc.) depending on your progress. This is extremely variable between individuals, depending on the surgical findings and the length of symptoms prior to surgery.
Most patients are walking relatively pain-free by 4-8 weeks. Remember, however, that it may take 3 to 6 months (or more) to return to an elite level of competition/fitness. Any unexpected increase in pain can be treated with ice packs and anti-inflammatory medication. The broad strategy for rehabilitation is to regain early range of movement and stability, followed by strength and endurance. Return to work will depend on pain levels and the nature of your job.
Potential risks and complications of hip arthroscopy:
All surgery carries risks, although every effort is made to minimize them. The complications can be temporary or permanent. Reassuringly, permanent complications following hip arthroscopy are rare and the majority are temporary. There are, however, risks which include the standard risks of undergoing general anesthesia and specific risks associated with hip arthroscopy.
- Matthew Plante, M.D.