Patient Guide To Femero-Acetabular Impingement And Hip Arthroscopy

The aim of this information sheet is to provide a provide Mr Parminder Singh’s patients a general guide to understanding what is femero-acetabular impingement, the assessment and investigation process and finally the hip arthroscopy surgical treatments. Every patient and every operation is unique and therefore this guide will not be able to answer all your questions.

This guide is not a substitute for obtaining medical advice from your surgeon. However, this guide may assist you to get a better understanding of what to expect and it may help you think of questions to ask Mr Parminder Singh. If this patient information guide does not answer your questions, remember that Mr Parminder Singh will do his best to do so at your consultation. Mr Singh and his surgical team will practice in accordance with the ethical standards defined by the Australian Medical Council.

What Is Hip Arthroscopy?

Hip arthroscopy is a minimally invasive surgical procedure that allows visualisation of the hip joint via a telescope type device known as an arthroscope via 1-2cm key holes incisions through the skin.

During the procedure, the surgeon will be able to assess the condition of hip joint and diagnose and potentially treat hip injuries and disease.

Why Would I Need Hip Arthroscopy Surgery?

Individuals affected with symptomatic femero-acetabular impingement have been identified as at increased risk of developing arthritis in the hip joint.

Early intervention in the form of hip arthroscopy is an option of treatment that can help improve the symptoms, individuals often get with femero-acetabular impingement. Long term studies (>10 years) are awaited to see if the arthritis process can be prevented or delayed.

Patients typically will suffer from the following symptoms:

  • Pain located in the groin
  • Associated pain particularly in the buttuck, side of the hip (lateral hip pain) , inside of thigh (adductors) and thigh region
  • Pain during activities walking, sitting to standing, running and twisting
  • Pain that has not improved with medicine and or physiotherapy for at least three months
  • Athletes, sportsmen, sportswomen and dancers typically describe pain on training and early fatigue. These symptoms will improve with rest but often recur on resumption of exercise.

What Conditions Does Hip Arthroscopy Surgery Treat?

Mr Parminder Singh most commonly see’s two distinctive types of femoro-acetabular impingement (FAI) are recognised. In practice it is common to see a mixed Cam and Pincer pathology, occurring along the anterior femoral neck and the anterior–superior acetabular rim.

Pincer Impingement

Occurs as a result of anterior over coverage (red triangle –figure B) of the acetabulum (socket) or acetabular retroversion causing abutment against the femoral head neck junction during hip flexion (figure c) causing damage to the hip joint particular the acetabular labrum

Where pincer type impingement predominates, abduction and external rotation movements may be more troublesome. A significant proportion of female patients with impingement will report exacerbation of their symptoms during sexual intercourse. In cases of pincer type impingement ranges of movement may appear normal but with pain towards the extremes of movement.

Surgery/Hip pincer impingement, PJS Orthopaedics Melbourne

Cam Impingement

Occurs when a non-spherical femoral head (red semi-circle see figure B) abuts against the anterior acetabulum (C), usually with the hip in flexion causing damage to the hip joint, particularly the cartilage and labrum. In patients where cam impingement predominates, symptoms are often precipitated by prolonged upright sitting and internal rotation movement in flexion.

An examination of the hip joint will often reveal asymmetric ranges of movement and evidence of irritability. Cases of large Cam impingement typically show reduced internal rotation of the hip in flexion. A portion of individual will have the condition affecting both hips.

Surgery/Hip cam impingement, PJS Orthopaedics Melbourne

Other Conditions Hip Arthroscopy Treats:

  • Acetabular labral tears
  • Femero-acetabular impingement (FAI)
  • Cartilage Repair
  • Ligamentum teres tears
  • Synovitis
  • Early arthritis in selected cases
  • Losse bodies
  • Synivial chondromatosis
  • Gluteal tendinopthy
  • Trochanteric Bursitis
  • Great trochanteric pain syndrome
  • Snapping hip includiung snapping iliotibial band and iliopsoas
  • Pain total hip replacement in selected cases

What Is The Process Moving Forward?

Step 1: Book A Consultation

If you do require surgery, we will schedule and walk you through the process of your operation.

Step 2 Schedule Surgery

If you do require surgery, we will schedule and walk you through the process of your operation.

Step 3 Surgery

Dr Parminder Singh will see you before the surgery in the waiting bay and ensure all your questions have been answered prior to surgery.

Dr Parminder Singh will examine your hip, thigh and leg making sure there are no open wounds or signs of skin infection.

If there are any signs of infection, you surgery will be cancelled and rescheduled for another day.  Once this has been check Dr Parminder Singh will draw an arrow on the side of your thigh confirming with you the side of surgery. Dr Parminder Singh will check your consent form to again confirm the operation being performed and side of surgery.

Step 4 Recovery

Following you surgery, you will recover on the ward. Most individual stay one night in hospital and will be seen by the physiotherapist on the ward to facilitate mobilisation using crutches for the first 1-2 weeks.

Some individuals will use the crutches for longer depending on the type of injury and treatment required.  Dr Parminder Singh will see you in his rooms approximately 10-14 days after the hip arthroscopy surgery and inspect the hip wound.

The stitches will be removed during this appointment.  Dr Parminder Singh will also explain the operative findings and recommended precautions and rehabilitiation required. Another appointment will typically be organised for you around 6-8 week after this date to assesss your progress.  In the meantime, rehabilitation is usually recommended with a physiotherapist who has experience with hip arthroscopy patients.

It is important to follow the hip precautions Dr Parminder Singh recommends to allow for the best possible outcome.

Any further appointement will be made on a case by case basis depending your condition. In general terms Dr Parminder Singh recommends approximately 3 months for healing from the surgery and hip precautions during this periods.

For Further Information Please Refer To Dr Parminder J Singh’s Patient Guides

Expert hip diagnosis and treatment. Focused on you. Dr Parminder J Singh provides quality patient advice and care in the field of orthopaedics.

Click here to view all patient guides.

Frequently Asked Questions About Hip Arthroscopy?

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.

Hip arthroscopy surgery is performed under general anaesthetic and you will meet your anaesthetist on the day of your 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 to three small incisions are made on the side of the hip measuring 1-1.5cm in length. This allows the procedure to be performed. The incisions are closed with stiches and covered with a waterproof dressing.

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 particularly around the groin, buttock and thigh can persist for up to three months following your surgery.

This is all part of the surgical healing process.  You will require crutches for a few days and possibly longer (this depends on the individual). Following your surgery you will be reviewed by Mr Singh at approximately 10-14 days 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 Mr Singh will guide you through your recovery plan. 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.

All surgery carries some risks.  Complications following hip arthroscopy surgery are rare,

Complications can include general surgical risks as well as specific hip arthroscopy risks: General surgical risks comprise Standard anaesthetic risks which your anaesthetist will explain to you. Infection risk would be approximately 1:1000. Blood clots (thrombosis) in the leg following hip arthroscopy are exceptionally rare and Mr Singh recommends you were compression stocking (TEDS) 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 are rare and comprise 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 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 where the blood supply to the ball of the hip joint could be lost is very rare.  Fractured neck of femur is very rare following bone removal. Abdominal compartment syndrome is caused by 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.

Book a Consultation

Committed to improving the quality of patient advice, treatment and care in the field of orthopaedics, book a one-on-one consultation with Dr Parminder J Singh today.

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