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Hip Arthroscopy

Indications for Hip Arthroscopy

Indications

  1. Diagnosing unexplained hip pain
  2. Removal of loose or foreign bodies
  3. Repair of damaged articular cartilage
  4. Removal or repair of a torn acetabular labrum (see below)
  5. Correction of femoroacetabular impingement (FAI – see below)
  6. Management of damaged hip ligaments/hip joint infection
  7. Inflammation of the hip lining (synovitis)
  8. Investigation of a painful joint replacement or hip resurfacing

The two most common current indications for hip arthroscopy are described below:

Femoroacetabular Impingement (FAI)

  • FAI is characterised by abnormal contact between the femoral head (ball) and the rim of the acetabulum (socket) leading to damage of one or both of the articular cartilage (lining) in the acetabulum, and the labrum (see right) of the hip. Activities that involve recurrent hip motion can increase the frequency of this abnormal contact, e.g. kicking sports
  • The labrum is a ring of cartilage that surrounds the acetabulum. Damage to the labrum and/or articular cartilage may cause pain. An abnormality in the shape of the femoral head or acetabulum may cause FAI
  • FAI can affect all age groups from the early teens throughout adult life and is being increasingly recognised as one of the predisposing factors for osteoarthritis of the hip
  • Hip arthroscopy can be used to reshape the femoral head and socket to prevent impingement, and aims to protect the hip from developing osteoarthritis, as well as relieving current symptoms.

Acetabular Labral Tears

  • The labrum can be partially damaged or torn. This can be associated with FAI, but can also occur independently. With a hip arthroscopy, the labrum can be either debrided (removing the damaged tissue) or repaired
  • MRI and/or CT scans, although often performed before hip arthroscopic surgery is undertaken, do not always reveal every labral tear.

How do we perform Hip Arthroscopy?

  • The hip joint is separated by approximately 1cm when applying traction to the foot. This provides enough room for a small telescope (arthroscope) to be introduced into the joint. Initially, air and/or fluid are injected into the hip under x-ray guidance. Once correct placement of the instrument has been confirmed, up to four small incisions are made on the (front) side of the hip. Each of these incisions generally measures approximately 5-10mm in length
  • Through these small holes the surgeon can then visualise the hip joint, identify the problem(s), and proceed appropriately
  • At the end of the procedure, medications may be injected into the hip to minimise post-operative pain after surgery. The small holes are often closed with one to two stitches each or tapes. Some surgeons choose to let the wounds heal naturally, without closure. Finally, a further dressing is placed over the holes
  • The surgery usually takes an hour. If more extensive work is required, then it may take longer
  • It is usual for you to stay in overnight, but some patients can go home on the same day.

What happens after surgery?

You will be seen by a physiotherapist following your surgery. They will make sure you are safe to mobilise with crutches. In most circumstances you will be asked to limit the amount of weight you put through your operated leg. Usually you will need crutches for 2 weeks depending on the type of surgery. If bone is removed from an impingement lesion that is extensive or if you have a cartilage defect that requires drilling or micro fracture technique, we will often ask you to stay on crutches for 4-6 weeks

  • An ice pack may help decrease pain and swelling. This can be used for 15-20 minutes, 3-4 times a day
  • Observe the wound for any signs of infection (increased pain, redness or swelling). The skin incisions can sometimes leak a little fluid or blood for a few days; this is normal. However, if this persists beyond 48 hours please contact your consultant
  • Bruising around the wounds and stiffness in the hip joint should be expected. You may have some ankle discomfort from the traction that is used to give access to your hip joint during surgery
  • Numbness in the thigh is very common for the first 24 hours. Occasionally numbness in the groin/thigh and genitalia can persist for a few weeks
  • After surgery you will be reviewed by your surgical team. Bruising around the wounds and stiffness in the hip joint should be expected. You may have some ankle discomfort from the traction that is used to give access to your hip joint during surgery
  • Your surgeon has an appropriate rehabilitation program for you following the surgery. Your outpatient physiotherapist/consultant will guide your return to sporting activities depending on your progress
  • Generally, it will be about 2 weeks post-operatively before you are comfortable enough to drive, depending on the leg operated on. Note that if your right leg was operated on, you should be able to perform an emergency stop before you commence driving again
  • You may travel once you feel comfortable; however, it is best to wait until 2 weeks post-operatively. If you need to travel long haul within 6 weeks, please inform the practice to discuss options to decrease the risk of DVT
  • Your follow-up appointment is already booked. This is on the letter that was sent to you with the details of the surgery. Please contact the surgery if you wish to change the appointment time. The appointment is usually within 2 weeks from your surgery
  • There are some activities to avoid or take care with up to 8 weeks following surgery. These include the following:
    • Prolonged standing, especially on hard surfaces
      – Prolonged walking i.e. around shopping centres
    • Heavy lifting
    • Squatting / crouching
    • Sleeping on your side. Try to sleep on your back. If you must sleep on your side, sleep on the unoperated side, with a pillow under your operated leg to hold that leg level with the body
    • Clutch use in manual cars (for left hips) – may flare up symptoms in the first couple of weeks and is best avoided
    • Sitting with the hips at 90 degrees a more open seat angle is recommended i.e. 120 degrees
    • Car seats should be tilted backwards slightly in order to open the hips out
  • You can shower post-surgery as you will be discharged with a waterproof dressing on. You will also be given some spare dressings to take home, in case your dressing loosens, or when the dressing needs changing
  • Should you have any medical concerns, please contact the Practice Nurse to discuss these further.

Initial exercises

The exercises that follow are aimed to restore range of movement over your hip, and to begin increasing your muscle strength. They should be done with minimal pain. Note that initially you may experience some stiffness which is normal, but do not force any movement at this stage. Your consultant will usually send your postoperative mobilisation protocol to your physiotherapist. If you had a labral repair, do not bend your hip past 90 degrees until advised.

Do the following 6 exercises about 3-4 times daily (one set) and repeat all about 5-10 times (with the exception of exercise 1).

1. Abdominal Setting

In lying, gently pull your lower abdominal muscles towards your spine (away from a belt). Hold the contraction for 3 seconds, relax and repeat 10 times. Try to increase the contraction time to 10 seconds. Do not hold your breath while doing this exercise. When you are able to sit, you can perform this exercise in an upright sitting position. Ensure that your spine is in neutral.
For all exercises we recommend that you first “set” your abdominal muscles prior to moving the leg.

2. Leg Slides in Supine

Slide the heel of your operated leg towards you, keeping your heel on the bed.

3. Abduction in Supine

Take your operated leg out to the side as far as you comfortably can, and then take back to the centre.

4. External/Internal Rotation in Supine (rolling leg around its axis)

With your legs straight out in front of you, roll them inwards and outwards, as far as you comfortably can.

5. Hip Flexion in Standing

Lift your operated leg to bend your knee towards 90 degrees.

6. Hip Extension in Standing

Bring your operated leg behind you, whilst keeping the knee straight, avoiding lower back movement. Hold for 2 seconds.

Continue these exercises until you see your consultant or physiotherapist.