What is the hip arthroscopy?
Hip arthroscopy is minimally invasive surgery of the hip performed through small incisions using a camera to visualize the inside of a joint. Through several small incisions (about 1 centimeter each) your surgeon will insert a camera into one incision, and small instruments through the other incisions.
What is the benefit of hip arthroscopy compared to open surgery?
The nice part about hip arthroscopy is that it is much less invasive than traditional hip surgery. This means:
o Early rehab
o Accelerated rehab course
o Outpatient procedure
o Smaller incisions
o Early return to sport
What conditions can be treated with hip arthroscopy?
· Labral Tear
The labrum of the hip is a cuff of thick tissue that surround the hip socket. The labrum helps to support the hip joint. When a labral tear of the hip occurs, a piece of this tissue can become pinched in the joint causing pain and catching sensations.
· Loose Bodies
Loose bodies are pieces of cartilage that form within the joint. They look like small marbles floating within the joint space. These loose bodies can become caught within the hip during movements.
· Snapping Hip Syndrome
Snapping hip syndrome has several causes, some of which can be treated with hip arthroscopy. If something is catching within the hip joint, hip arthroscopy can be used to relieve this snapping. Also, hip arthroscopy can be used to perform a psoas tendon release in cases of internal snapping hip syndrome.
· Cartilage Damage
In patients with focal cartilage damage, meaning not widespread arthritis, hip arthroscopy may be helpful. These patients may sustain an injury causing a piece of cartilage to break away from the surface of the bone. These patients may benefit from removal of that piece of cartilage.
· Femoro-acetabular impingement (FAI)
This is a condition where there is the specific finding of impingement (pinching) within the hip joint due to extra bone or a bone growth from either the femoral head or the acetabular rim. Patients may benefit from removal of the bone spurs causing this impingement.
What are the risks and possible complications from hip arthroscopy?
The most concerning complications of hip arthroscopy have to do with several important nerves and blood vessels that surround the joint. Nerve injury is uncommon, but can be a significant problem. The most commonly affected nerves include the sciatic nerve, the lateral femoral cutaneous nerve (sensation to the thigh), and the pudendal nerve. Injury to any of the nerves can cause pain and other problems.
Other possible complications from hip arthroscopy include potential injury to normal structures, infection, and continued pain after the surgery. The rate of these complications is low, but patients need to understand the potential prior to undergoing a hip arthroscopy.
What are the benefits of hip arthroscopy?
The benefit of hip arthroscopy is that the recovery is much simpler than for open hip surgery. Patients can typically put as much weight as tolerated on the hip immediately following surgery (check with your doctor as some procedures may limit weight bearing).
In the first weeks after surgery, patients work on regaining motion around the joint, and gentle strengthening exercises. Some patients may need to work with a physical therapist for assistance with these exercises and stretches.
Most patients can begin light activities (cycling, swimming) within a few weeks. Athletes most often take about 12 weeks for recovery. Again, there are specific procedures that may require a more lengthy rehabilitation, so check with your doctor about the specific plans for your recovery.
FREQUENTLY ASKED QUESTIONS
1. How long will I be out of work?
Sedentary work can be resumed in one to two weeks. Labor intensive work maybe eight to 12 weeks.
2. How long until I can drive?
One week as long as your feeling well enough and are off narcotics.
3. Will there be any rehab involved?
Most patients don’t require dedicated therapy. When you do, it could be for as much as two to three months.
4. How long before I can exercise?
Stationary bike and elliptical are a part of the rehab and may begin as soon as one week.
5. During surgery, will I be put under?
Yes. I don’t recommend nerve blocks or regional anesthesia because of the potential for nerve injury that I would want to diagnose and treat early.
6. Will I have crutches after surgery, how long will I use them?
Yes, but most patient s can come off them in two weeks. Your rehabilitation progress, as well as the extent of the tear and/or associated problems, will determine the weaning process.
7. What kind of restrictions will I have after surgery?
You will be partial-weight bearing (on crutches) for five to seven days and progress to full weight bearing as tolerated. This will be altered or slowed slightly if articular cartilage problems are found and treated.
8. Is it possible that I have damaged cartilage? Will you find this out prior to or during surgery?
Yes. As hip arthroscopy techniques become more refined the incidence and ability to treat cartilage problems are both increasing. The presence of cartilage lesions (articular cartilage) is specifically defined at the time of surgery.
9. If I don’t have surgery, can I ever play soccer or other active, aggressive sports again? If I rested for a while and felt better, can I cause more damage if I go back to my normal activities?
Conservative care is always an option. If you follow a conservative treatment plan of active rest, stretching and strengthening, the pain and swelling may go down. If however, you have a labral tear which is a mechanical issue, the pain and swelling will return once you return to your chosen sport.
10. Will surgery prevent further damage to the ligament/cartilage? What are the chances of reoccurrence?
Surgery is done for pain and to reduce worsening of the tear. There is no assurance that a recurrent tear will not occur. Recurrent tears are, however, unusual.
11. How much could the pain subside without surgery?
The pain may wax and wane, but likely would not decrease significantly or for an extended period of time without surgical intervention.
12. What can I do to put less tension on the hip? Are there any exercises, stretches or devices to use to help me sleep better?
All activities, even rolling over in bed can cause hip stresses. The most important exercises are ones which create normal flexibility about your hip and normal, protective strength.
13. What are the chances that I could feel worse after the surgery?
Though feeling worse after surgery is always a possibility, the incidence of that is very small.
14. Is there anything I can do to give me any relief now? Ice and heat seem to only do so much.
Pain medications can be ordered but are not recommended prior to surgery. Anti-inflammatories (Advil) and Tylenol mixed together are often better than either alone.
Sample Hip Arthroscopy Rehabilitation Protocol
Phase I - Initial phase
Goal: Regain range of motion within tolerance, decrease pain and swelling, neutralize muscle atrophy
· Day of surgery
o Isometric gluteal sets
o Ankle pumps
o Heel slides
· Post-operative days 1-7
o Weight bearing with crutches
o Isometric quadriceps, gluteals, hamstrings, adductors, and abductors
o Active assist range of motion all planes
o Hip mobilization and gentle joint distraction techniques
o Closed chain bridging, balance drills
Phase II - Intermediate phase
Goal: Regain and build muscle strength, focus on symmetry/core strength
· Post-operative weeks 2-3
o Wean crutches and normalize gait pattern
o Increase range of motion limits
o Gentle progressive resistive exercises
o Closed chain single leg bridging
o Open chain hip 4-way
o Mobilization with movement
o Proprioceptive/balance work
o Stationary bike/aqua therapy
Phase III - Advanced phase
Goal: Improve functional strength and endurance, core strength & stability
· Post-operative weeks 4-6
o Continue flexibility exercises
o Progressively increase resistive and functional strengthening exercises
o Initiate sport specific exercises
o Gradual return to sport
Note: Weight bearing may be limited after some surgical procedures with a hip arthroscopy, including:
o Labral repair
o Iliopsoas release
o Microfracture
o Capsulorraphy
Individual rehabilitation protocols will vary by patient and procedure, this information is simply a guide to the rehabilitation following hip arthroscopy for some patients.