Hip Arthroscopy Surgery Guide

Written by Dr Parminder J Singh MBBS, MRCS, FRCS (Tr&Oth), MS, FRACS

Orthopaedic & Trauma Surgeon

Specialist in Hip & Knee Key Hole Surgery

Hip & Knee Replacement Surgery

 

The aim of this information sheet is to provide a general overview of your hospital stay, anaesthetic, details of surgery, experience after surgery, post-operative care information and potential complications. If you have any further questions or concerns please discuss directly with Dr Singh during your consultation.

 

Hospital Stay

You will be admitted to hospital on the day of surgery, and this procedure usually requires an overnight stay in hospital. Just prior to your surgery the site of surgery will be cleaned and marked for surgery.

Post-Operative Care Information – 2 Weeks Following Surgery

Mobilisation

Following surgery, you are able to walk. It is important to try to maintain a normal walking pattern and avoid limping. Generally most patients are able to wean themselves of crutches within the first 2-3 weeks. Crutches may be used initially to assist you with walking. The physiotherapist will assist you and guide you through this process. You may weight bear on the operative leg, unless specifically requested not to, by Dr Singh.

 

If you are using crutches, wean yourself off them as soon as you like, provided you are not limping. If one crutch is needed for a short period, it should be used in the opposite hand to the operative leg. You may need to discuss the appropriate time to stop using crutches with the physiotherapy team.

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Anaesthetic

Hip arthroscopy surgery is performed under general anaesthetic and you will meet your anaesthetist on the day of your surgery.

 

Details of Surgery

The procedure requires the bones of the hip joint (ball and socket) to be separated by approximately 1-1.5 centimetres (cm). This is achieved by applying traction using special boot that will be strapped to your foot. Under x-ray control, air and fluid are injected into the hip to safely allow the introduction of a small telescope (arthroscope) and the surgical instruments into the joint.

 

Two, and occasionally three, small incisions are made on the side of the hip measuring 1-1.5cm in length. This allows the procedure to be performed. At the end of the procedure, a combination of local anaesthetic, anti-inflammatory and morphine are injected into the hip to reduce post-operative pain. The incisions are closed with sutures and covered with a waterproof dressing.

Post-operative Pain

Some pain and tightness may be experienced around the incision sites on the hip. Observe the wounds for signs of infection which include: hot, painful, redness and swelling. Please contact your General Practitioner or the Consulting Suites if you are concerned. This is extremely rare occurrence.

 

You should be walking relatively pain free 12 weeks post-surgery. Up until then you may experience some pain or ache around the site of surgery, groin, thigh and or buttock. Your return to work will depend on your pain level and your job requirements. Most patients return to work within two weeks on light duties. Dr Singh will be able to advise you further on this during the consultation.

It is normal to experience some post-operative discomfort and swelling in the groin, thigh, lower back and buttock regions. Some degree of pain or ache can persist for up to three months following your surgery. This is all part of the healing process. On average, 70-80% of patients report an improvement in their symptoms, 10-15% report no significant improvement and 5% may find their hip is worse.

 

You may require crutches for a few days and possibly longer (this depends on the individual).

 

You will be reviewed by Dr Singh at approximately 10-14 days post-surgery to remove the stitches from the wounds. This appointment will be made prior to your surgery and will be documented on your confirmation of surgery form. The details of the surgery will be discussed with you at this appointment and Dr Singh will guide you through your recovery.

 

Arrangements for any physiotherapy or rehabilitation can be made at your two week appointment. This is also a good time to ask for any medical certificates that you might require to be completed.

Every patient and every operation is unique and therefore this Hip arthroscopy guide will not be able to answer all your questions.

If you have any questions, simply book a consultation today.

Hip Arthroscopy Surgery - A Patient's Guide

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2

Post-Operative Care Information – 6 Weeks Following Surgery

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6

Physiotherapy

Physiotherapy can start approximately 10 days post-surgery. Dr Singh does not recommend hip flexion greater than 90 degrees or excessive rotation of the hip, deep squats, clams and lunges for the first 6-12 weeks following surgery. Your physiotherapist can design an individualized movement, strength and rehabilitation program for you focusing on making the muscles working in a coordinated manner from the lower back, abdomen, hip, knee and ankle.  They will be able to guide you with time-frames of returning to sporting activities depending on your progress. This will vary for each person and depends on the surgical findings and degree of symptoms prior to surgery. High seat cycling can be attempted 2-3 weeks after surgery and continued providing this does not cause a flare up of your pain. Initially 5 minutes building up to 20 minutes is recommended.

 

Running should not be attempted before 6 weeks after surgery in order to avoid the risk of fracture. It may take up to 12 weeks for an elite sports person to return to their previous level of competition and fitness.

 

Swimming and hydrotherapy can commence when your wound is healed. Do not attempt breaststroke. Flippers may assist to even out your kick, but do not use them to kick hard.

 

Treat any flare up of pain with cold packs, analgesia and anti-inflammatory medication. Your General Practitioner can assist with pain management during your rehabilitation.

Activities to avoid / take care with for 6-12 weeks post-surgery

  • Sleeping on your side. If you must sleep on your side, then choose the no-operative side to lie and put a pillow between your legs to support the top leg level with the rest of your body. Sleeping on your back is better.

 

  • Sitting with the hips at 90°. An open sitting angle of 120° is recommended. Car seats can be released back to allow for the open sitting angle that helps to open the hips out.
  • Prolonged standing – especially on hard surfaces, prolonged walking & heavy lifting.

 

  • Deep squatting, crouching, lunges, clams or excessive rotation of the hip joint.

 

  • For left hip procedures, please drive an automatic car. Using the clutch may cause symptoms to flare up in the first couple of weeks and is best avoided.

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Tips for Patients

  • Prepare your home – Try to organise your home so that things are easy to access. You may experience discomfort, particularly when bending over, getting in and out of a chair, getting in and out of bed during the first few days so make things easy for yourself and get some help from a friend or family member.

 

  • Toilet seats – Initially, going to the toilet may be uncomfortable and a raised toilet seat can be helpful. Bending over – Within to first two weeks, try to avoid to bending over too often.

 

  • You may find it easier of you can get some assistance putting on your shoes, socks and compression stockings.

Potential Risks and Complications

All surgery carries some risks. Complications following hip arthroscopy surgery are rare, however, can include general surgical risk as well as specific hip arthroscopy risks:

 

General surgical risks comprise

  • Standard anaesthetic risks.

 

  • Infection – the exact rate of infection is unknown, but would certainly appear to be approximately 1:1000.

 

  • Thrombosis – clots in the leg following hip arthroscopy are exceptionally rare and Dr Singh recommends you were compression stocking for two weeks following your surgery and will provide you with blood thinning injection at the time of your surgery to reduce to the risk of any clots developing.

 

  • Bleeding – this is can occur if a major blood vessel is damage and is extremely rare.

 

Specific Hip Arthroscopy risks

  • Nerve paraesthesia or numbness – sometimes the leg traction used during the procedure can lead to pressure on the nerves in the groin. This can cause temporary numbness around the groin or genitalia. This is uncommon and although there is a theoretical risk that this numbness could be permanent, there has been no such problem and all cases of numbness have recovered usually in a few days. Numbness can around the incisions is rare and can lead to permanent numbness or altered sensation around the side of the hip.

 

  • Avascular necrosis of the femoral head – the blood supply to the ball of the hip joint could be lost, but this is very rare.

 

  • Fractured neck of femur – this is very rare following bone removal.

 

  • Abdominal compartment syndrome – fluid extravasation into the abdomen is extremely rare.

 

  • Technical complications – in certain hips it may not be possible to access the hip joint safely and the surgery may need to be abandoned in order to avoid any damage. Also, instruments can break within the joint which may require open surgery if they cannot be retrieved through the key hole incisions. This is extremely uncommon.

IF YOU HAVE ANY QUESTIONS ABOUT THE PROCEDURE OR POST-OPERATIVE CARE, PLEASE DISCUSS THESE WITH DR SINGH DURING YOUR PRE-OPERATIVE AND POSTOPERATIVE APPOINTMENTS.

 

For further information go to the International Society of Hip Arthroscopy Website:

http://www.isha.net/isha-publications.asp

 

HIP ARTHROSCOPY A Patient’s Guide

Guidance prepared on behalf of the International Society for Hip Arthroscopy (www.isha.net)

Authors: Singh PJ, O’Donnell JM, Pritchard MG