Hip arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems within the hip joint. This procedure involves the use of an arthroscope, a small camera that allows surgeons to view the inside of the joint and perform the necessary interventions. Hip arthroscopy is commonly recommended for people experiencing hip pain or limited mobility due to conditions such as labral tears, femoroacetabular impingement (FAI), or cartilage damage.
Reasons for Hip Arthroscopy
Hip arthroscopy is typically performed to address a variety of hip joint issues, including:
Labral Tears: The labrum is a ring of cartilage that surrounds the hip socket. Tears in the labrum can cause pain, clicking, or locking sensations in the hip.
Femoroacetabular Impingement (FAI): FAI is a condition where abnormal bone growths on the hip bones cause friction during movement, leading to pain and potential joint damage.
Cartilage Damage: Damage to the cartilage within the hip joint can result from injury or degenerative conditions, leading to pain and limited movement.
Loose Bodies: Small fragments of bone or cartilage can become loose within the joint, causing pain and movement restrictions.
Synovitis: Inflammation of the synovial membrane, which lines the joint, can cause pain and swelling.
Benefits of Hip Arthroscopy
Hip arthroscopy has several benefits compared to traditional open surgery, including:
- Minimally Invasive: Smaller incisions result in reduced tissue damage and scarring.
- Reduced Pain: Patients typically experience reduced post-operative pain.
- Faster Recovery: Shorter hospital stays and faster return to normal activities.
Preparation for Hip Arthroscopy
Steps to prepare include:
Medical Evaluation
A thorough evaluation by your doctor to ensure you are a suitable candidate for the procedure. This may include a physical examination, medical history review, and imaging tests such as X-rays or MRI scans to assess the condition of your hip joint.
Medications
Discuss any medications you are taking with your doctor. You may need to stop certain medications before surgery. This includes blood thinners, anti-inflammatory drugs, and certain supplements that could increase the risk of bleeding or interfere with anaesthesia. Your doctor will provide specific instructions on which medications to discontinue and when to resume them.
Fasting
You will likely need to fast for several hours before the procedure. Typically, this means not eating or drinking anything after midnight on the night before your surgery. Fasting is necessary to reduce the risk of complications during anaesthesia. Your doctor will give you detailed instructions on how to prepare.
Transportation
Arrange for someone to drive you home after the surgery, as you will not be able to drive yourself. The effects of anaesthesia and pain medications will impair your ability to drive safely.
The Hip Arthroscopy Procedure
Hip arthroscopy is performed under general anaesthesia and typically involves the following steps:
- Preparation: The patient is positioned on the operating table, and traction is applied to the leg to create space within the hip joint for the arthroscope and surgical instruments.
- Incisions: Small incisions are made around the hip to insert the arthroscope and surgical instruments.
- Examination and Repair: The surgeon inserts the arthroscope into the joint, allowing the surgeon to view the interior on a monitor. Surgical instruments are used to repair or remove damaged tissue as needed.
- Closure: After the necessary repairs are made, the instruments are removed, and the incisions are closed with sutures or surgical tape.
Recovery and Rehabilitation
Recovery from hip arthroscopy varies depending on the individual and the specific procedures performed. Key aspects of recovery include:
Initial Recovery
Patients typically spend a few hours in the recovery room before being discharged. Crutches may be needed to assist with walking initially. It’s important to follow the surgeon’s instructions on weight-bearing and activity restrictions to ensure proper healing.
Pain Management
Pain and swelling are common after surgery. Medications and ice packs can help manage these symptoms. Patients may be prescribed pain relievers and anti-inflammatory drugs to reduce discomfort. Elevating the leg and avoiding strenuous activities can also aid in managing pain and swelling.
Physical Therapy
A structured physical therapy programme assists in regaining strength and mobility in the hip joint. Exercises will gradually progress to restore full function. Physical therapy usually begins with gentle range-of-motion exercises, followed by strengthening exercises. The goal is to improve flexibility, build muscle strength, and enhance overall joint function.
Follow-Up Visits
Regular follow-up visits with the surgeon are required to monitor healing and address any concerns. These visits help ensure that the recovery is on track and allow the surgeon to make any necessary adjustments to the rehabilitation plan. Follow-up appointments are typically scheduled at regular intervals over the first few months post-surgery.
Expected Recovery Timeline
The recovery timeline can vary but generally follows these stages:
First Week
During the first week after hip arthroscopy, the primary focus is on rest and limited movement to aid in the initial healing process. This period is important for allowing the surgical site to begin healing without additional strain. Managing pain and swelling is also a significant aspect of this stage, and patients should follow the prescribed pain management plan, which may include medications and the application of ice packs to reduce discomfort and inflammation.
2-6 Weeks
Between two to six weeks post-surgery, patients can start to gradually increase their level of activity as tolerated. It is important to follow the surgeon’s instructions on when it is safe to start moving more and putting weight on the hip. Physical therapy typically begins during this period, where a structured programme is introduced to improve the range of motion and start strengthening the hip muscles. The exercises at this stage are gentle and designed to enhance mobility without causing additional stress to the healing joint.
6-12 Weeks
From six to twelve weeks, patients continue with their structured physical therapy programme, focusing on regaining full mobility and strength in the hip joint. The exercises will progressively become more challenging to help restore function and support a return to everyday activities. Patients may be able to resume more of their daily activities, but it is important to avoid high-impact or strenuous activities until the surgeon provides clearance. This phase is about steadily increasing activity levels while ensuring the hip is healing correctly.
3-6 Months
Most patients can return to their normal activities within three to six months post-surgery, though some may need more time depending on the extent of the surgery and individual healing rates. Continued participation in any recommended exercises and regular follow-up appointments with the surgeon are vital to ensure proper healing and to address any ongoing concerns. While many patients feel significantly better within a few months, full recovery may take up to a year. Patients should continue to follow their surgeon’s advice to ensure a successful and complete recovery.
Risks and Complications
As with any surgical procedure, hip arthroscopy carries potential risks and complications, including:
- Infection: There is a small risk of infection at the incision sites or within the joint.
- Blood Clots: Blood clots can form in the legs or lungs after surgery, though this is rare.
- Nerve or Vessel Damage: The proximity of nerves and blood vessels to the hip joint means there is a slight risk of injury during the procedure.
- Stiffness: Some patients may experience stiffness or reduced range of motion in the hip joint after surgery.
- Incomplete Relief of Symptoms: While hip arthroscopy can be effective, some patients may not experience complete relief of symptoms.
Conclusion
Hip arthroscopy is a minimally invasive surgical procedure that treats various hip joint conditions. If you are experiencing hip pains, consult with an orthopaedic surgeon to determine if hip arthroscopy is an appropriate option for you.
Dr Wang Lushun specialises in enhancing recovery after hip surgery. He specialises in Direct Anterior / Direct Superior Minimally Invasive Approaches to the hip using the latest modern implants.
