Introduction to Hip Arthroscopy

Hip arthroscopy is a minimally invasive surgical procedure used to diagnose and treat various conditions within the hip joint. Unlike traditional open surgery, which requires larger incisions, hip arthroscopy involves making small incisions through which a camera and surgical instruments are inserted. This technique allows orthopaedic surgeons to view the hip joint without making a large cut, leading to less tissue damage, reduced pain, and a quicker recovery time for patients.

Indications for Hip Arthroscopy

Common Conditions Treated with Hip Arthroscopy

Hip arthroscopy is utilized to address a variety of hip conditions, most notably:

  • Labral Tears: Injuries to the labrum, the ring of cartilage surrounding the socket of the hip joint, often caused by trauma, femoroacetabular impingement (FAI), or degenerative changes.
  • Femoroacetabular Impingement (FAI): A condition where extra bone grows along one or both of the bones that form the hip joint, giving the bones an irregular shape and causing them to rub against each other.
  • Loose Bodies: Small pieces of bone or cartilage that have broken off and float within the joint space, causing pain and joint locking.
  • Synovitis: Inflammation of the synovial membrane, the lining of the joint, which can cause significant pain and swelling.
  • Early Hip Arthritis: In some cases, hip arthroscopy can be used to treat early stages of arthritis, especially to clean out loose cartilage or bone debris causing pain.
Symptoms Indicating the Need for Hip Arthroscopy

Patients may consider hip arthroscopy if they experience:

  • Persistent hip pain that does not improve with non-surgical treatment methods such as physical therapy or medications.
  • Difficulty in performing daily activities or sports due to stiffness or reduced range of motion in the hip.
  • Sensations of clicking, locking, or catching within the hip joint.

Preparing for Hip Arthroscopy

Undergoing hip arthroscopy requires several preparatory steps to ensure the safety and effectiveness of the procedure. Patients are advised to:

Preoperative Testing

Complete any required preoperative tests, such as blood tests, ECG, or additional imaging studies, to assess the patient’s overall health status.

Medication Review

Discuss current medications with the healthcare provider, as some medications may need to be temporarily stopped before surgery, especially those that can increase bleeding risk, such as blood thinners.

Preparation at Home

Prepare the living space to accommodate mobility limitations, such as placing frequently used items within easy reach and securing rugs to prevent slips.

Fasting Before Surgery

Follow instructions regarding fasting, typically no food or drink after midnight on the day of surgery, to reduce the risk of complications during anaesthesia.

Physical Preparation

Depending on the surgeon’s advice, physical therapy exercises might be recommended before the surgery to strengthen the muscles around the hip, which can aid in recovery.

The Hip Arthroscopy Procedure

Hip arthroscopy is performed under general anaesthesia, with the patient typically lying on their back or side. The procedure involves the following steps:

  1. Anaesthesia: The patient is placed under general anaesthesia, ensuring they are asleep and pain-free throughout the procedure.
  2. Positioning and Preparation: The leg may be placed in traction to create more space within the hip joint for the insertion of arthroscopic instruments and allow the surgeon to access the joint easily.
  3. Making the Incisions: The surgeon makes several small incisions around the hip area. These incisions are typically less than half an inch each.
  4. Inserting the Arthroscope: A thin tube with a camera and light (arthroscope) is inserted through one of the incisions to provide the surgeon with a clear view of the hip joint on a monitor.
  5. Surgical Procedure: Specialized instruments are inserted through the other incisions to perform the necessary repairs or treatments.
  6. Closure: Once the procedure is completed, the incisions are closed with stitches or small bandages.

The entire procedure typically takes a few hours, depending on the complexity of the surgery and the specific treatments being performed. Patients are usually able to go home the same day of the surgery, once they have sufficiently recovered from anesthesia and their vital signs are stable.

Recovery and Rehabilitation

In the initial phase after hip surgery, managing pain with prescribed medications and ice, resting, and using crutches or a walker are key steps. Keeping the incision clean and starting gentle exercises to improve mobility, followed by strength training, are crucial.

Patients typically resume daily activities within a few weeks, but returning to strenuous activities depends on individual recovery and the orthopaedic surgeon’s advice. Recovery times vary based on several factors, including the patient’s health and adherence to rehabilitation.

Risks and Complications of Hip Arthroscopy

Like all surgical procedures, hip arthroscopy carries a risk of complications, although it is generally considered safe and effective. The potential risks and complications include:

  • Infection: Although rare, there is a risk of infection at the incision sites or within the hip joint.
  • Nerve Damage: The surgery may inadvertently affect nerves around the hip, potentially leading to numbness or tingling in the thigh or foot.
  • Blood Clots: There is a risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), especially if mobility is reduced during recovery.
  • Bleeding: As with any surgery, there is a potential for bleeding during or after the procedure.
  • Pain: Some patients may experience persistent pain in the hip area after the surgery.
  • Limited Improvement: In some cases, the surgery may not provide the expected improvement in hip function or pain relief.
  • Joint Stiffness: The hip joint may become stiff, especially if the post-operative rehabilitation is not followed as recommended.

Outcomes and Expectations

Many patients experience significant pain relief and improved joint function following hip arthroscopy, especially for conditions like labral tears and femoroacetabular impingement (FAI). Enhanced mobility and a return to daily activities and sports are common benefits. However, the full advantages may emerge gradually, over months, as the hip heals and strength is regained through rehabilitation.

High patient satisfaction rates post-surgery are reported, particularly among those who adhere closely to their rehab programs and have realistic recovery expectations.