Hip Arthroscopy

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Several hip conditions can be treated with less invasive surgery using an arthroscope. The instruments are introduced through two to four small incisions and major surgery can be completed with minimal external scarring. See Figure A1, Figure A2, Figure F1, Figure F2, and Figure F3.

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When is it used

  • To find the cause of hip pain and evaluate the condition of the hip joint.
  • Removal of unhealthy tissue, loose bone, cartilage fragments and foreign bodies.
  • Treat labral and cartilage tears with repair or reconstruction.
  • Reshaping of the ball and the socket to relieve hip impingement.

How is it done

A significant force is applied to pull on the leg to create space between the ball from the socket. Xrays are used frequently. A large amount of fluid is pumped through the hip to keep the hip distended and the camera picture clear. Narrow camera and instruments are inserted through small incisions and the joint is inspected and any problems are treated. 

Advantages

Less tissue injury, less pain, less blood loss, quicker recovery

Disadvantages

In addition to complications that can occur after any surgery, certain complications are rare, but unique to hip arthroscopy.

  • Damage to the healthy cartilage of the hip during passage of instruments through tight spaces
  • Abdominal distension from fluid leaking from the hip into the abdomen
  • Nerve damage from compression from pulling on the leg. This can cause numbness and weakness in the leg and in the genital area. 

 

Hip Arthroscopy Post-operative protocol

Day # 0

  1. Compression bandage, tighten muscles of buttock, thigh, and leg.
  2. Keep hip abducted, slightly flexed, and in neutral rotation. Avoid hip flexion more than 80 degrees.
  3. Bear weight as tolerated with two crutches or a walker.
  4. Take pain meds as needed.
  5. Aspirin 325my once a day for 10 days.

 

Day # 1

  1. Remove bandage and apply water proof band aids. May shower while keeping the incisions clean and dry.
  2. Shallow squats with support. 10 per session three times a day for 2 weeks.
  3. Stationary cycle twice a day. Build up to 20 minutes at low resistance each session for 2 weeks.
  4. Place bent knee on a chair while standing straight and rotate the hip in both directions.

 

Day # 14

  1. Remove sutures.
  2. Increase resistance on the bike.
  3. Deeper squats without support.
  4. Use one crutch in the opposite hand.
  5. Left the leg sideways while lying on the opposite side and knee and hip held in line with the trunk. 10 reps twice a day.
  6. Lay prone and stretch the hip backwards.

 

Day # 28

  1. Stop crutches if able to.
  2. No restrictions.
  3. Squats, lunges, jogging as tolerated and work towards sports and normal activities.
  4. Consider formal physical therapy for evaluation and strength training.

 

Day # 42

Resume running and sports as tolerated