What is a Hip Arthroscopy?
Arthroscopy is a surgical procedure that gives doctors a view of the inside of a joint using a special camera known as an arthroscope. During the operation, the surgeon will make small incisions (usually about 1 centimeter wide each) and then insert the camera into your hip joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide fine surgical instruments which are also introduced to the hip joint via small incisions.
This operation is known as a ‘minimally invasive procedure’ which means that the incisions used by the surgeon are very small in comparison to a procedure such as a hip replacement which requires the joint to be opened surgically. For this reason it is often referred to as ‘key hole surgery’.
Hip arthroscopy has been performed for many years and is used to treat a wide range of conditions.
Who is this operation for?
Hip arthroscopy has a wide range of applications. Often an initial course of conservative management including rest, anti-inflammatory treatment, and exercise therapy may be tried before the operation is carried out. The following conditions may require an arthroscopic procedure:
- Hip impingement: Femoroacetabular Impingement (FAI) is a disorder that can affect up to 25% of people. The hip joint is a ball and socket joint made up of the femoral head (ball) and the acetabulum (socket). When either the ball or socket is abnormally shaped, it can cause abnormal friction and movement, leading to pain, stiffness and arthritis. Hip impingement has been identified as a leading cause of hip arthritis.
- Labral tears: Around the socket (acetabulum), the rim is lined by special cartilage called the labrum that gives extra stability to the joint. It acts like an O-ring found in taps or other plumbing. Labral tears are commonly found in association with hip impingement.
- Cartilage damage: Cartilage damage can be cleaned up, removed and “microfractured”, so that new types of cartilage can line your joint and help relieve the pain.
- Loose bodies: Pieces of cartilage or bone may break off from the hip joint and become lodged in the joint space. These can be removed during an arthroscopy.
- Early arthritis: Often it is best to treat the cause of your arthritis, by removing the hip impingement and repairing the labral tear.
- Ligamentum teres tears: This ligament is a cord like structure which connects your ball to the socket. Tears of the ligament can be cleaned up and tightened using specialised instruments and injected with a steroid.
- Hip Joint infection: Arthroscopy can be helpful in obtaining specimens of the bacteria causing the infection which can lead to more effective antibiotic treatment. During the procedure it may also be possible to remove any debris resulting from the infection.
- Unresolved hip pain: Sometimes arthroscopy may be used as an exploratory technique to find out what is causing the hip pain and remove any structures that are contributing to the problem.
What are the benefits of the key-hole surgery?
Key-hole hip arthroscopy is a highly specialised technique that is much less invasive than traditional open surgery. It requires much experience and specialist training to perform properly.
Patients who have key-hole arthroscopic surgery rather than open surgery benefit from:
- Earlier rehabilitation
- Accelerated rehab course
- Smaller incisions/wounds
- Early return to sport
Complications
Because hip arthroscopy is performed using small incisions, complications following the operation are relatively rare. No operation however is without risks.
The specific risks of hip arthroscopy include:
- Nerve injury: Nerve injury is very uncommon, but can be a significant problem.
- The most commonly affected nerves include
- the sciatic nerve
- the lateral femoral cutaneous nerve (sensation to the thigh),
- pudendal nerve (from the foot traction)
- Injury to any of the nerves can cause pain, lost of sensation, pins and needles, and other problems.
- Injuries to nerves are often temporary, but can be permanent
- The most commonly affected nerves include
- Infection: infection is a risk with every surgical procedure. With modern surgical technique and sterilisation, it is a rare but important risk to consider.
- Continued pain after the surgery: depending on your individual circumstance, complete relief of your pain and symptoms may not be achievable.
The general risks of any surgery include:
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- blood tests
- Xray hip
- Xray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Get some help from your friends and family
Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended-care facility during your recovery after surgery also may be arranged.
Home Planning
The following is a list of home modifications that will make your return home easier during your recovery:
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
- A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
- Raised toilet seat
- A stable shower bench or chair for bathing
- A long-handled sponge and shower hose
- A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
- A reacher that will allow you to grab objects without excessive bending of your hips
- Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
About the Operation
Hip arthroscopy can be done as a day procedure, but it is best when you stay overnight so that our nurses can take the best care of you.
During the hip arthroscopy, you are placed on your side and your foot is placed in a traction device so that space can be created in the hip joint.
Usually 2 – 3 incisions about 1 cm wide are made around the side of your hip. Special cameras and surgical instruments are passed through these incisions to perform your operation.
The procedure can last between 30 – 90 minutes, depending on what needs to be done.
Local anesthetic is placed into your hip before and after the operation, so that you have as little pain as possible.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.
Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery.
The operation is usually less painful than expected as local anaesthetic is given throughout the operation, and pain relievers can be taken regularly after the operation.
The physiotherapist will visit you on the ward so teach you some exercises and help you use your crutches.
Recovery and Rehabilitation
Most people can go home the next morning. You will need someone to drive you home and attend to you, especially on the first night after surgery. You can also expect to be on crutches, or a walker, for some time after the surgery.
It is normal to feel some discomfort and perhaps some swelling in the groin, thigh, lower back and buttock regions. Occasionally patients have some numbness or tingling in the foot, leg, groin, or genitalia, which resolves.
It’s best to take at least 2 weeks off work to recover properly.
- Office work: 2 weeks
- Manual work: 6 weeks
It is important to see the physiotherapy team who will provide a rehabilitation program. A full regimen of return to sport and work will be tailored to your needs by our physiotherapy team. In general:
- 4 weeks: stationary cycling
- 6 weeks: slow tread-mill until running
How long will it take to heal?
The incisions are healed between 7 and 14 days.
Most patients improve dramatically in the first 6 weeks and continue to get better over the next year. This is heavily dependent on the amount of damage to the lining of the hip, or arthritis, found at the time of surgery. It is not unusual to have times where the hip becomes quite sore and then settles again. This is part of the normal healing process.
Are there important things I need to tell my doctors?
It is important to let your doctor know if you experience any of the following symptoms
- Redness, swelling or warmth around the incisions
- Leakage from the incisions
- Fever and chills
- Severe hip pain that is not relieved by prescribed painkillers
- Loss of control over leg movement
- Loss of leg movement
F.A.Q.s | Frequently Asked Questions
What are the alternative treatments to having a Hip Arthroscopy?
Before any surgery is performed, you should always consider the non-operation alternatives. You can discuss this with your orthopedic surgeon.
Are there important things I need to tell my doctors?
- Redness, swelling or warmth around the incisions
- Leakage from the incisions
- Fever and chills.
- Severe hip pain that is not relieved by prescribed painkillers.
- Loss of control over leg movement
- Loss of leg movement
What is the normal recovery like after a hip arthroscopy?
It is normal to feel some discomfort and perhaps some swelling in the groin, thigh, lower back and buttock regions. Occasionally patients have some numbness or tingling in the foot, leg, groin, or genitalia, which resolves.
When can I start walking?
Everyone is slightly different in their response to the surgery. The majority feel good enough to walk the next day, sometimes with crutches for support. Where bone is removed, it is a good idea to only put a small amount of weight on the leg, and use crutches while it is still painful.
Can I change the dressing?
Yes. It is normal for the wounds to ooze some fluid. It is best that a trained nurse or doctor changes the dressing under sterile conditions to reduce the chance of infection.
When can I drive?
You shouldn’t drive in the first 48 hours after an anaesthetic. It is reasonable to drive when you have good movement and can walk and put weight on the leg.
When can I return to work?
This varies considerably with type of work, and details of procedure.
- If your work involves mainly office works, then you can return to work after 1 – 2 weeks.
- If your work involved heavy lifting or manual labour, you may need up to 4-6 weeks off work.
How long will it take to heal?
The incisions are healed between 7 and 14 days.
Most patients improve dramatically in the first 6 weeks and continue to get better over the next year. This is heavily dependent on the amount of damage to the lining of the hip, or arthritis, found at the time of surgery. It is not unusual to have times where the hip becomes quite sore and then settles again. This is part of the normal healing process.
When do I start Physiotherapy?
Immediately after the operation.
For the best results, physiotherapy should start before the operation so that the muscles can be trained and the exercises learnt that are needed for the best and fastest recovery.