Getting to know you series – Hip Arthroscopy

What is Hip Arthroscopy?

Arthroscopy is a term derived from the Greek words “arthro” which means “joint”, and “skopein” which means “to view or observe”. Therefore, hip arthroscopy is a minimally invasive surgical procedure performed through 2 or 3 small 5-10 mm incisions (i.e., key hole surgery), using an advanced HD 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.

What are the risks of hip arthroscopy?

Complications are not common, but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision on the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your surgeon.

Some patients occasionally report numbness or tingling in the groin or inner thigh. This usually resolves with time. It is quite normal to experience some swelling and discomfort in the leg, thigh and buttock region. This is expected and will also resolve with time. It is important to avoid high-impact activities during the early phase of recovery to minimise the risk of fracture.

Other general surgical risks include risk of infection, bleeding and clots in the leg (DVT) or lung, postoperatively.

Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well being and health.

For more general information on all surgery including arthroscopy, the Australian government has developed the health direct website.

Rehabilitation and recovery after hip arthroscopy

Participating and completing a tailored exercise program before (i.e. pre-hab) and after surgery (i.e. rehab) with a trained physiotherapist will achieve the best result for you post-surgery.

Post-surgery, immediate mobilisation and weight-bearing is allowed. Initially, crutches may be required for support. independent walking is usually achieved by week 2 post-surgery. Returning to work, particularly low-impact office work, is also possible within this period.

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 (i.e. with the hip in excessive flexion >90 degrees, adduction and internal rotation) such as lunges, squats, passive stretches, sitting in a low chair and prolonged driving.

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.

Goals of hip arthroscopy pre-hab and rehab:

• Education
• Muscle retraining and rebalancing:
  • Target muscles: short ER, quadratus femoris, ab-adductor, quad-hamstring
• Motor control (isolated activation)
• Active range of motion (extension to flexion)
• Strength and endurance
• Posture, balance and gait retraining
• Functional exercises
• Sports-specific training and returning to sport

What conditions does hip arthroscopy treat?

This list is by no means exhaustive, but some of the common conditions treated include:

Hip arthroscopy has revolutionised the treatment for femoral acetabular impingement (FAI).

• Abnormal ball (i.e. cam lesion): The abnormal bone is removed, thus reshaping the ball to prevent further impingement and protecting the hip from further damage. This also improves your range of motion.
• Abnormal socket (i.e. pincer lesion): The abnormal bone is removed, thus preventing further impingement and protecting the hip from further damage.
• Labral tears: These can be repaired and stabilised. Specialised anchors are used to re-attach the torn labrum.
• Ligamentum teres tears: These can be trimmed, tightened and stabilised. Any inflamed tissue is removed.
• Bone cysts (acetabular or femoral): These can be removed or filled with a bone graft.

In addition to FAI, other hip conditions that benefit from hip arthroscopy include:

• Articular cartilage damage (early arthritis): If caught early, articular cartilage damage can be repaired and stabilised. Otherwise, unstable flaps can be removed and the underlying bone prepared to encourage new cartilage to form, a process known as ‘micro-fracture’.
• Synovitis: Inflamed tissue around the hip can be removed (i.e. synovectomy).
• Abductor tendinopathy: Radiofrequency (RF) tenoplasty can be performed to stimulate neo-vascularisation (i.e. new blood vessel formation) to promote tendon healing.
• Trochanteric bursitis: The inflamed bursa is removed (i.e. bursectomy) and an iliotibial band (ITB) release is performed to decompress the inflamed area.
• Psoas tendinopathy: The inflamed tendon can be lengthen to reduce irritation and inflammation.
• Loose body: Bone, cartilage or any other loose tissue can be removed to prevent ongoing damage to the hip.
• Biopsy: Tissue specimens can be taken to aid the diagnosis of certain conditions.
• Washouts: For the treatment of hip infections.

As always at ARTHRO Health, we are here to help. Please contact our rooms for more information on hip arthroscopy or to organise a time to meet with Mr Andrew Chia to discuss your individual needs.