Dr Ray Randle: 07 5598 0094
Dr David Liu: 07 5598 0205
Dr Haig Lennox: 07 5598 0531

Hip Arthroscopy

Hip arthroscopy is a surgical procedure using a camera and special instruments to visualise and work inside and around the hip joint. A specially designed hip traction table is used to allow access into the hip joint.

Hip arthroscopy is a minimally invasive technique resulting in less tissue damage, less pain, less blood loss, and faster recovery and return of function than open surgical procedures. Patients are allowed to immediately weight-bear and walk, and can go off crutches as soon as they are able.

Some of the common conditions treated include:

  • Femoro-acetabular impingement (FAI): Removal of Cam and Pincer lesions
  • Labral tears – These can be repaired and stabilised
  • Articular cartilage flaps – repaired, stabilized, removed and micro-fractured
  • Synovitis – Inflamed tissue around the hip can be removed (synovectomy)
  • Washouts – For the treatment of hip infections
  • Loose bodies – Bone, cartilage or any other loose tissue can be removed
  • Ligamentum Teres tears – These can be trimmed, tightened and stabilised
  • Trochanteric bursitis – Inflamed bursa is removed (bursectomy) and an iliotibial band (ITB) release is performed to decompress the inflamed area
  • Abductor tendinopathy / tears – Can be assessed, debrided, repaired or trephined in combination with bursectomy +/- ITB release
  • Psoas tendinopathy – Assessment and tenotomy can be performed

Goals and Outcome

The goal of hip arthroscopy, like most other surgery, is to eradicate pain, resolve symptoms and improve function to allow return to normal work and play. Many people (75%) experience a favorable outcome after hip arthroscopy. However, the results will depend upon the type of damage before the procedure. Degenerate arthritis will generally have a poorer or less predictable outcome. For some, lifestyle changes will be needed to protect the hip joint from further damage. Although hip arthroscopy is successful at treating a number of conditions, it may only be a stopgap procedure for some patients who may eventually require a total hip replacement.

As part of the preparation for surgery, the better informed and prepared the patient is, the better the likely outcome. Signing an informed consent is a vital part of preparing for surgery. Attending a preadmission clinic is helpful. Many steps and actions are taken to reduce the risks of surgery and to aid in an uneventful full post-operative recovery.

Surgical Procedure

  • Surgery is performed under anaesthesia with muscle relaxation
  • The operative leg is put in traction to pull thehip (head)away from the socket to create spacetosee the entire joint surface, and insert instruments
  • After traction is applied, using X-rays, needles are used to gain access into the hip joint
  • 2 or 3 small 5-10mm incisions (key hole surgery) are made
  • The arthroscope is introduced
  • Through the arthroscope, the inside of the hip is viewed and the damage/problemidentified
  • Other portals (holes) are created for instruments (tissue ablators, probes, nibblers, shavers, burrs, suture passers, anchors) to perform the necessary procedure
  • X-rays are used to assist bone resections
  • Local anaesthetic is infiltrated into the hip and around the wounds
  • Wounds are sutured and dressed

Post-operative care

  • Hip arthroscopy usually requires an overnight stay in hospital
  • Most patients are pleasantly surprised at how little pain they have after the procedure. Local anaesthetic is injected before and after the procedure to minimise any pain. Patient controlled analgesia if often used
  • Immediate mobilisation and weight-bearing is allowed
  • Initially, crutches may be required for support. Independent walking is usually achieved by week 2 post-surgery
  • Wounds will require dressings for 10-14 days
  • Avoid soaking wounds for 2 weeks (baths and swimming)
  • Returning to work, particularly low impact office work, is also possible within this 2 week period
  • You will be safe to drive you vehicle when you are no longer using crutches and not requiring powerful analgesia
  • A progressive range of movement and gentle strengthening program guided by a physiotherapist can be commenced at 2 weeks post surgery
  • Low impact activities, such as cycling and swimming, may be commenced from week 4
  • Where bone is removed as part of the procedure, high impact activities, such as running and jumping, are best avoided for six weeks post-surgery
  • During the initial six weeks after surgery, it is best to avoid activities in the ‘impingement’ positions (ie. with the hip in excessive flexion > 90 degrees, adduction and internal rotation)eg.lunges, squats, passive stretches, sitting in a low chair and prolonged driving
  • Occasionally, there are periods where the hip may become sore and then settle again. This in not uncommon and may require a period of backing off exercises
  • Sport specific retraining can commence 6 weeks after surgery, with the aim of returning to elite level sports within 3 months post-surgery
  • It will take 3 months for your hip to fully recover from hip arthroscopy
  • Continued improvements may be gained up to 1 year post-surgery

Risks and Complications

Complications are uncommon, but always possible. Prior to making any decision to have surgery, it is important that you understand the potential risks inorder to make an informed decision on the advantages and disadvantages of surgery.

The following list of complications is by no means exhaustive:

  • Persistent pain
  • Clicking, snapping, grating, catching or locking
  • Numbness around the surgical sites, between the legs or in the feet
  • Infection, superficial of deep
  • Post operative stiffness and or weakness
  • Fractures
  • Nerve, artery injury
  • Hip avascular necrosis
  • Hip instability
  • Progression of hip arthritis
  • Anaesthetic complications
  • DVT and Pulmonary embolism

The patient is a very important part of the pathway pre and post surgery. Patients need to be responsible for there own health and follow recommendations. Informing the doctor or appropriate professionals if there is a concern. Early diagnosis and treatment of complications will improve the success of treatment.

Hip Arthroscopy

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