Arthroscopic Hip Surgery
What is it?
The hip joint is a ball (femoral head) and socket (acetabulum) joint. The joint surfaces are lined with smooth cartilage (articular). A special layer called the capsule or synovium lines the joint. The socket has a fibro- cartilaginous ring surrounding it called the labrum, which acts as a fluid seal and enhances joint stability.
The predominant condition it is used to treat is femoro-acetabular impingement (FAI) where abnormal bony contours occur either at the femoral head/neck junction (CAM) or around the socket (pincer) of the hip joint; simply, the ball and socket do not fit perfectly, causing friction during hip movements, resulting in damage to the labrum and/or the articular cartilage. The abnormal contours can be removed (shaved away) and any damage to the labrum and articular cartilage evaluated and treated if necessary.
It is only recently that the expertise and specialist equipment has evolved to facilitate this surgical procedure safely and accurately.
Who should have hip arthroscopy?
The majority of patients are:
• Young, active individuals with a history of hip pain during or after activity and of gradual onset that has not responded to anti-inflammatory medication and/or physiotherapy.
• Patients with sudden onset of hip pain after a traumatic injury.
This procedure cannot be used to treat established arthritis effectively
Will I need any tests/scans?
Plain X-rays, MR arthrogram and CT scans are usually required before this type of surgery.
How is it done?
The operation is carried out under Spinal / general anaesthetic. Traction is required to distract the hip joint to allow the surgeon to introduce the arthroscope (fibre-optic camera) and other instruments into the joint. Usually two or three small incisions (portals) are required.
Can I go home the same day?
More often than not, as with most arthroscopic surgery, this is a day case procedure. Occasionally an overnight stay is advised depending on post- operative comfort levels and time of day of the surgery.
What about after the operation?
You will see a physiotherapist before discharge to be instructed on crutch use and simple exercises to carry out in the short term. Crutches are advised for a few days to several weeks depending on the surgery performed.
Surgery for FAI is usually followed by 4 weeks of partial weight bearing with crutches. Passive range of movement exercises and static bike exercises can start as soon as comfort allows, but greater movement and hip strengthening does not commence until the crutches have been discarded.
Sutures are removed two weeks after surgery and a physiotherapy program will ensue thereafter which is paramount to the success of the operation.
What are the potential complications?
All surgery carries a risk. Specific risks to hip arthroscopy are:
Infection – this can be either superficial (portals) or within the joint.
Thrombosis – a clot in the deep veins of the lower limb. The risk is minimised by early mobility if possible. Oral contraceptive pills and HRT, which are known to increase risk, should be stopped before surgery.
Bleeding – this may require a return to the operating room for removal of blood clots and to stop the bleeding.
Stiffness – It is very important that some mobility of the hip is maintained after surgery. The physiotherapist will advise on simple exercises that can be carried out at home.
Fracture – when treating FAI and shaving bone at the femoral head/neck junction, the removal of bone may temporarily weaken this area of the joint, predisposing it to fracture if excessive load or strain is placed upon the head/neck junction too early.
Residual symptoms – unfortunately, no guarantees can be offered regarding curing your symptoms, despite the surgeon’s best efforts. In this case, further management and treatment options will be discussed with you.
Other – due to the fact the procedure is performed using traction, muscular discomfort around the hip and lower back and very occasionally, temporary numbness in the groin and thigh can occur.
