Dr. Peatman's Hip Arthroscopy
What is Hip Arthroscopy?
Hip arthroscopy is a minimally invasive procedure performed in a surgery center which may be used to treat many causes of hip pain. Through small incisions (about 1 centimeter each) around the hip joint, your surgeon will insert a camera and small instruments into the inside of the hip joint to treat hip pathology, including labral tears of the hip, hip impingement, loose bodies, and cartilage damage.
What conditions can be treated with Hip Arthroscopy?
Cam Hip Impingement
When the ball of the hip has an oval shape rather than being perfectly round, it can jam inside the edge of the round socket as you bend your hip up. This deformity can frequently be treated using hip arthroscopy to reshape the ball. This is a common cause of hip pain in young patients and is often associated with a tear of the labrum and damage to the lining cartilage of the hip socket.
The labrum of the hip is a gasket of tissue that surrounds the rim of the hip socket. The labrum helps to support the hip joint and acts as a bumper between the ball and socket as the hip bends. When a labral tear of the hip occurs, a piece of this tissue can become pinched in the joint causing pain and “catching” sensations.
Pincer Hip Impingement
This occurs when the front edge of the hip socket overhangs the front of the hip joint too far. When flexing the hip, the ball can catch against the edge of the socket causing labral damage and damage to the cartilage at the edge of the hip socket.
Loose bodies are pieces of cartilage that form within the joint and can get caught within the hip during movement.
In patients with focal cartilage damage (meaning not widespread arthritis), hip arthroscopy may be helpful.
What are the possible complications from Hip Arthroscopy?
Complications of hip arthroscopy are uncommon but may include injury to nerves or vessels around the hip joint. The most commonly affected nerves include the lateral femoral cutaneous nerve which provides sensation to the thigh, and the pudendal nerve which provides sensation to the groin. This is due to the pressure required to traction the hip out of joint to perform the procedure. Generally symptoms of nerve injury including pain and numbness last only a short time after the procedure, usually recovered from in a few days, but may take up to 6 weeks or longer to fully recover.
Other possible complications from hip arthroscopy include potential injury to normal structures within the hip joint, infection, and continued pain after the surgery. It is estimated that 10% of patients will have a complication of some sort or undergo an unsuccessful hip arthroscopy which does not improve pain levels. These patients may go on to need an another hip surgery.
Planning for Surgery
- If you have certain health risks, you may need a physical examination from your doctor to assess your health. You may also need pre-operative blood work and an EKG.
- If you take aspirin or other blood thinners you will need to stop them one week before surgery.
- You should see us in the office within the month prior to your procedure at which time we will go over all necessary instructions with you as well as prescribe pain medication which you will need after surgery.
- Your hip arthroscopy will be performed as an outpatient in a surgery center. The surgery center will contact you ahead of time to provide specific instructions. Make sure to follow the instructions on when to arrive and when to stop eating or drinking prior to your procedure (generally the night before your surgery).
- Before the operation, you will also be evaluated by your anesthesiologist. Hip arthroscopy is most commonly performed under general anesthesia, where you go to sleep for the operation.
- Plan to be out of work after surgery for about one week for most sedentary jobs, however it may be several months to return to manual labor type jobs and athletics.
At the start of the procedure, your leg will be put in traction to allow full visualization and treatment of the hip joint. Several small incisions will be made around the hip joint depending on your needs. The length of the procedure will depend on what your surgeon finds and the amount of work to be done.
After surgery, you will stay in the recovery room for approximately one hour before being discharged home. You will need someone to drive you home. Once you get home, you should take pain medications as needed, as prescribed at your preoperative visit. You may also begin, with the help of a friend or family member, the exercises for motion of your hip and the CPM machine (see rehabilitation section below).
In some cases, crutches are necessary, but only until any limping has stopped. If you required a more extensive procedure, however, you may need crutches for 1 to 2 months. A CPM (continuous passive motion) machine may have been arranged for home use starting the day after surgery. Don't worry if you did not get one. Additionally a family member may help you in the early phases of rehab to regain motion of your hip.
You may remove the bandages and shower 48 hours after your surgery. In most cases, physical therapy is necessary to achieve the best recovery. We will arrange for this at your first post operative visit.
Once your wounds have healed you may benefit from warm water pool activities. Follow the advice of your therapist. An Aquajogger may be helpful to keep you afloat in deep water while rehabbing. In the pool you may work on all motions of the hip, as well as “water biking” and “water walking/jogging”.
For more information on Aquajogger visit: www.aquajogger.com
In general, your rehab goals will be initially to decrease pain and swelling and regain range of motion of the hip. Eventually you will progress to regain and build muscle strength and focus on symmetry/core strength, stability and endurance. With the ultimate goal of returning to full sport and work activities.
Frequently Asked Questions:
Webster Orthopedics | 80 Grand Avenue #400 | Oakland, CA 94610
Clinic Phone: 510-238-1200 | Appointments: 800-943-8099