Certain hip conditions may require surgery – especially if conservative treatment options have not been successful. For example, a labral tear often requires the torn tissue to be surgically reattached to the bone or cleaned up to stop mechanical symptoms like popping, clicking, or catching. Advances in surgical technology now allow us to treat conditions that previously were left untreated. Hip surgeries other than a total joint replacement can be done through an arthroscope, including impingement, bony defects, and labral tears. Often times, multiple hip conditions can be addressed at one time with arthroscopic hip surgery.
Hip arthroscopy is an outpatient procedure, which means you do not have to stay overnight in the hospital. For this procedure, you will arrive at the facility about an hour and a half before your actual surgery time. Our staff will check you in and conduct a brief health check by listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We will then start an IV to give you fluids and medications. The anesthesia staff will discuss your options for medications during surgery. Often times, a general anesthetic will be used in conjunction with a nerve block; the anesthetic will put you to sleep and the nerve block will numb your leg and hip during and after the surgery. The nerve block can last up to 24 hours after surgery, which helps to manage the initial discomfort caused by the surgery. Your surgery time can vary depending on how much repair needs to be done, but can last anywhere from one to three hours.
Once you are fast asleep in the operating room, your hip gets filled with saline. Saline helps expand your joint, making it easier for your surgeon to move surgical instruments and better see tissues. To be able to see inside of your joint, your surgeon will use a special table that applies traction to separate your thighbone from its socket on the pelvis. Your foot gets strapped into a boot that pulls your leg away from your pelvis creating more space in the hip joint for the surgical instruments.
Once there is more space, your surgeon puts an arthroscope into your hip, which is a tiny camera hooked up to a large computer screen. This magnifies the structures in your hip and allows your surgeon to view it with their own eyes. Once your surgeon can see in the joint, they insert surgical instruments through another incision and are able to repair the damaged tissue. Often times, multiple tiny incisions are made to get to the different areas in your hip. While in your hip, your surgeon will usually fix any repairable damage they find, even if it was not expected before surgery. Even MRIs can miss damage in your hip, but during an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant (PA) often helps your surgeon throughout surgery and understands everything that was done during your surgery.
After surgery, your surgeon will explain what they found in the operating room to your family and discuss any limitations you will have in using your leg. You will be placed on crutches for the first day and remain on crutches until you regain full sensation in your hip. Before weaning off the crutches, you should be able to bear full weight and walk comfortably. If a repair is needed or more intensive work was done, you may need to use crutches without bearing any weight on the leg for a few weeks. Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After those few days, you may take off the bulky dressing from surgery and are allowed to shower. As you can imagine, it can be difficult to care for yourself after a hip arthroscopy, and you may find you need extra help. Your surgeon will be sure to tell your family if you have any specific restrictions after surgery.
After a hip arthroscopy, patients can expect to be seen by either their surgeon or a Physician Assistant in 10-14 days. At that time, they will discuss with you what they found during your surgery, what was done, and your recovery process. Sometimes you are able to begin moving your hip and returning to activities on your own, as you feel you are able. Other times you may require physical therapy. On average, it takes most patients one to two months before they are back to their daily activities, if a labral repair is done it can take up to three or four months before they are back to their regular activities; however it can take up to a year before they no longer notice any hip pain.
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Hard Cartilage Damage and Chondroplasty
The thigh bone is a long bone running from the knee up to the hip with a head shaped like a ball to fit neatly into a socket on the hip (acetabulum) to form the hip joint. These bony surfaces are covered by hard cartilage which should ideally be smooth. If there is a defect or flap in the hard cartilage it can cause your hip to have a painful catch or click and limit the motion of your hip. A damaged hard cartilage flap can catch and cause damage the remaining healthy tissue in your hip. If the defect is relatively small, it can sometimes be polished and smoothed out with gentle motion exercises like riding an exercise bike. If the hard cartilage damage is severe, surgical intervention may be required to remove unstable flaps of tissue.
A hip chondroplasty is an arthroscopic procedure to smooth out damaged hard cartilage. Once the problematic area is known, a surgical instrument is used to remove the fraying or flapped hard cartilage and smooth down the remaining tissue. After this procedure, you are often placed on crutches for a few days and may begin to wean from them as you tolerate. Your surgeon will tell your family exactly what your restrictions are after surgery.
Labral Tears and Debridement vs. Repair
The thigh bone is a long bone running from the knee up to the hip with a head shaped like a ball to fit neatly into a socket on the hip (acetabulum) to form the hip joint. Inside the socket is a flexible rim of soft tissue called the labrum, which helps increase the stability of the hip. The labrum can fray or completely tear causing a flap of tissue to catch within the hip joint. This can cause pain, popping, and a feeling of instability in your hip.
This condition can be treated with an arthroscopy. If the damage to your labrum is minor, you may only need a debridement. A surgical instrument is used to remove the fraying or flapped labrum and smooth down the remaining tissue. After only a labral debridement you are often placed on crutches and may begin to wean from them as you tolerate. For a completely torn labrum that requires repair, your surgeon will often use anchors made of a bone-like substance to sew your labrum back down to the bone. Over time, your body turns the anchor into your own bone. The number of sutures used during surgery will depend on the size and severity of your injury. After a labral repair will be given specific post-op instructions but you can expect to use crutches for up to 6 weeks. Your surgeon will tell your family exactly what your restrictions are after surgery.
Femoroacetabular Impingement (FAI) and Arthroscopic Femoroplasty
The hip consists of two bones: the thigh bone (femur) and the pelvis. The pelvis is made of two bones: the acetabulum (hip socket) and the sacrum. The thigh bone is a long bone running from the knee up to the hip. The head is shaped like a ball to fit neatly into a socket on the hip (acetabulum) to form the hip joint. Inside the socket is a flexible rim of soft tissue called the labrum, which helps increase the stability of the hip. Typically femoroacetabular impingement occurs because of a boney variation, during developmental growth stages or from bone spur formation later in life.
Femoral acetabular impingement (FAI) occurs when bone spurs form in various places in the hip. As a result, the head or ball of the thigh bone has abnormal motion within the hip joint and rubs on the hip socket. This can cause damage to the hard cartilage on the bone or the soft tissue labrum. There are different types of FAI depending on where the bone spurs form. Some form on the thigh bone while others form on the hip socket. Any of these can cause pain, limited motion, and more damage to other structures in the hip. Femoral acetabular impingement typically affects the hip joint in young and middle-aged adults.
During an arthroscopic hip surgery, your surgeon will use surgical instruments to go in the hip joint and remove any bone spurs or excess bone. Your surgeon may use fluoroscopy, a special type of x-ray, to determine when they have restored an appropriate shape to the hip socket and/or thigh bone. Any damage to the surround soft tissues in your hip joint will also be debrided or cleaned up. Sometimes repair to the labrum is necessary as well.
After a femoroplasty, you will go home using crutches for the first few days and then begin to walk as tolerated. Your surgeon will tell your family exactly what your restrictions are after surgery. The initial recovery for a femoroplasty is relatively short; however, the surface where the spur was removed can be sore for a few months following surgery, as it takes time for your body to develop a new hard covering on the bone. This procedure is typically very helpful for patients and the bone spurs rarely return.