Hip anatomy and arthroscopy background
The bones that make up the hip joint are the femur (the thighbone) and the pelvis. At the top end of the femur is a ball called the femoral head. The femoral head fits into a round socket on the side of the pelvis called the acetabulum. This ball and socket joint allows a large range of movement required for activities such as squatting , swimming and climbing.
Hip arthroscopy is a procedure where a camera is inserted into the joint to allow diagnosis and sometimes treatment of a variety of hip problems .
Why should I have a hip arthroscopy?
Common indications for hip arthroscopy are described below:
- Arthritis - Articular cartilage covers the ends of the bones in the joints of the body. In the hip, articular cartilage covers the femoral head and the acetabulum. It is white and shiny and allows the joint surfaces to slide against one another without causing any damage. When this articular cartilage gets damaged or starts to degenerate, it can cause pain in the joint. If pieces of this cartilage start to break off, ‘loose bodies' can get trapped in the joint.
- Impingement - The femoral head is attached to the rest of the femur by a short section of bone called femoral neck. In some patients, there is an overgrowth of bone at the femoral head-neck junction (cam impingement) or at the edge of the acetabulum (pincer impingement). This can cause pain when the hip is flexed; when knee comes towards the chest, across the body, or when sitting.
- Labral Repair & Reconstruction - A structure inside the hip called the labrum attaches around most of the edge of the acetabulum. The shape of the labrum and the way it is attached create a deeper cup for the acetabulum/socket. This small rim of cartilage can be injured and cause pain and clicking in the hip.
- Hip arthroscopy is keyhole surgery to deal with these problems - to smooth off (debride) damage to the articular cartilage and remove any loose bodies in arthritis, to remove any overgrowth of bone that is causing impingement and to debride and repair the acetabular labrum using arthroscopic techniques.
What should I do before my surgery?
Following consultation with Mr Hoad-Reddick, please contact the HR Orthopaedics office on 0161 722 0007 to arrange a convenient date for your surgery. If you are insured you will need to contact your insurance company and obtain an authorisation number which you should take with you on admission. Your insurance company may ask for a Procedure Code which is W1380 for a hip arthoscopy.
Prices for self-funding patients can be given on request; for more information on this please visit our self-pay information page. Patients often benefit from attending a few physiotherapy sessions before surgery and this is known as ‘PREhab’. This is a programme of exercises and advice to get them in the best possible condition before their operation. If this is something you would like then please ask Mr Hoad-Reddick to refer you to the physiotherapy department at your clinic appointment.
The hospital will contact you to attend for preoperative assessment approximately one week prior to admission. You will be required to fast for a period of time before your operation; this will be confirmed in writing along with your admission details.
What happens on the day of surgery?
You will be admitted to hospital usually the same day as your operation with a planned single overnight stay. When you are admitted to the hospital on the day of your surgery, you will see the anaesthetist who will discuss your previous history and ensure that you are fit for surgery. This will give you an opportunity to discuss any concerns you may have regarding anaesthesia. The procedure will be explained again and consent forms discussed and signed. The leg for surgery will be clearly marked with marker pen and you will be given an approximate expected time for your surgery. You will be taken down to theatre by a porter and handed over to the theatre staff. They will attach devices to you in order to monitor your heart rate and oxygen levels before administering the anaesthetic through a cannula (a very thin tube) in the back of your hand. Once you are asleep, you will be turned onto your side and three small incisions will be made in the side of your hip. Mr Hoad-Reddick will then assess the issues within your hip and treat any abnormalities where possible.
For more information on what to do when you are discharged, please download our Patient Instruction Leaflet.
What risks are associated with a hip arthroscopy?
All surgical procedures have associated risks. General risks include:
- Deep Vein Thrombosis (DVT) or clots in the leg which can occasionally lead to pulmonary embolism when a clot breaks off in the leg and lodges in the lungs, a rare but potentially fatal complication.
- Infection is a rare but serious complication, with an incidence of 1 in a 1000. If infection occurs in the joint, further surgery may be needed to wash out the joint and the outcome of your hip arthroscopy would be compromised.
- Surgery can cause injury to nerves and blood vessels leading to weakness, numbness and bleeding. This is very rare.
- The traction used in hip arthroscopy can cause bruising in the thigh and groin and may pull nerves leading to numbness in the groin, pelvis or foot. These complications usually reduce within 2-3 weeks and are much less common with the use of modern traction equipment.
- Excessive bone resection can risk fracture of the hip in the early post-op period, but this is extremely rare and minimized by meticulous surgical technique and careful bone resection.
How should I look after my surgical wounds?
- Hip arthroscopy is key hole surgery and you will have three small cuts in a triangle shape on the side of your hip. The cuts will have two stitches which will be removed at your two week follow up appointment. The cuts will be covered with a plastic, waterproof dressing and you will be given fresh dressings to change at home every few days. Keep the wounds clean and dry and contact Stafford Suite immediately on 0161 495 7022 if you have any discharge or redness around the incisions.
- A small amount of bruising around the cuts is normal and it will feel sensitive for some time, so it is unlikely that you will want to sleep on that side. Most patients sleep most comfortably on their back with a pillow underneath their knees, or on their non-operated side with a pillow between their knees. Apply ice to the outside of your hip for 10-15 minutes at least 4 times daily to reduce heat and swelling, using a thin cloth, such as a tea towel, between the ice and your skin.
- For more specific information download our Wound Care Information Booklet. or watch our UTUBE Wound Care clip.
How should I manage my pain after surgery?
There will be some degree of discomfort after any surgical procedure, but we will do everything we can to ensure that you have as little pain as possible. Local anaesthetic is often injected into the joint during surgery and this can lull you into a false sense of security when you wake up as the hip can often feel pain free for the first few days post-op. Do not be tempted to walk around without your crutches (even if you feel you could) as this can cause extra strain on the joint. Your awareness of the joint is reduced whilst the local anaesthetic is working putting you at high risk of further injury.
The amount of medication needed post surgery is extremely individual and you will be guided by the nurses, based off the pain levels you report to them. When you are discharged you will probably be prescribed pain killers and anti-inflammatory medication to take home. It is important that you take this medication as prescribed. Effective pain control is achieved by taking pain killers at regular intervals rather than with the onset of pain. Make sure you understand when you should be taking your medication, dose size and side effects. Patients often complain of spasms in the muscles around the hip in the weeks following surgery-these are perfectly normal and your physio will be able to show you how to manage them.
Contact Stafford Suite on 0161 495 7022 with any problems regarding pain management
What rehabilitation should I do after my surgery?
Physiotherapy treatment following your surgery is crucial to restore range of movement, strength and stability. Exercise and mobility are an extremely important part of rehabilitation and require full patient participation for optimal recovery and outcome.
In order to help you achieve this, you will see the inpatient physiotherapy team who will provide you with crutches and show you how to use them. (Please note that there is a charge for the crutches which your insurance may not cover). Our physiotherapists at BMI The Alexandra Hospital are highly experienced and the physiotherapist that sees you during your admission can arrange your outpatient physiotherapist follow up appointment with you. The team will also give you some basic exercises to do at home following surgery. It is crucial that you do these exercises to regain movement in the hip and maintain blood flow in the legs.
If you have your own physiotherapist, you should visit them one week post surgery. Please let the BMI inpatient physio know if you plan to continue your treatment elsewhere and they can ensure you have all relevant information for your physio.
Our hip arthroscopy physiotherapy booklet contains Mr Hoad-Reddick’s recommendations for your physiotherapist to follow regarding your rehabilitation. There are 2 protocols available for your physiotherapist - You can download a copy of the Simple Protocol here and the Complex Protocol here. If you are unsure which one you need please ask the BMI inpatient physiotherapist or Mr Hoad-Reddick.
How should I use crutches after my surgery?
You will be partial weight bearing on two crutches for a minimum of two weeks post-op, to reduce strain on the hip while it recovers and the muscles around the hip begin working optimally again.
Using two crutches can be challenging as you cannot carry things (eg. cups, plates) so please ensure that you arrange some help at home following the operation. Using a rucksack is also useful. Please do not stop using the crutches until your physiotherapist or Mr Hoad-Reddick tells you to. Otherwise you can place unnecessary strain on the healing tissues, even if you feel you could cope without them.
If your physio says that you can reduce to one crutch, make sure that it is held on the non-operated side.This means that if the left hip has been operated on, the crutch would be held in the right hand and the left leg and crutch would step forward at the same time. When climbing stairs, ascend with the non operated leg leading and descend with the operated leg leading. The physio will practice this with you before you are discharged.
How long will my recovery from surgery take?
On discharge, an appointment will be booked for you to attend Mr Hoad-Reddick’s outpatient clinic after ten to fourteen days for review and stitch removal.
The speed of your recovery depends on what was found and what procedures were required during your operation. Patients will usually be partially weight bearing on crutches for two weeks and off work for an average of four weeks. If however a microfracture procedure is necessary, crutches will be required for six weeks post-op. Please be aware that the full extent of the issue may not be fully clear until Mr Hoad-Reddick is inside the hip therefore any estimates of time off work given in clinical appointments may be subject to change. Return to work will also depend on the job that you do. He will do whatever is required to provide you with the best result long-term.
Returning to sport must be discussed with Mr Hoad-Reddick; patients are usually back to their sporting activities by four months post operation, although it can take a year for full recovery. Most people return to sport at a level they were at prior to their pain, however it is not yet clear to what extent the procedure stops the course of arthritis. Patients with pre-existing degenerative changes may not experience as much pain relief as a patient that simply has impingement.
Overall 85% of patients are delighted with the outcome showing significant change, 10% see no change and 5% see a deterioration in symptoms. If you require further information please visit the NICE website.