What is hip arthroscopy?
Hip arthroscopy (pronounced arth-ROS-copy) is surgery that involves a half-inch incision in the hip to access the patient's condition. Through this small incision, the surgeon inserts several portals (holes). Through one portal, he uses a tiny camera that transmits images to a television monitor, which guides him through the surgery. Through the other portals, he inserts thin instruments to perform the surgical procedure.
Before arthroscopy was developed, the surgeon had to make a longer incision and use larger instruments, which made for a more invasive procedure.
Hip arthroscopy offers some athletes and non-athletes a chance to resume and enjoy daily activities while avoiding invasive, open (large incision) surgery.
Who is a candidate?
People of all ages, from children to seniors, can be candidates for hip arthroscopy at Midwest Orthopaedics at Rush.
What are some of the conditions treated by hip arthroscopy?
Femoroacetabular Impingement (FAI)
Also known as hip impingement syndrome, this is a condition in which the hip bones are shaped abnormally. They rub together, causing damage to the cartilage and labrum in the joint which triggers pain. If this is diagnosed early, it can be corrected through arthroscopic surgery. Arthroscopic surgery can help them not only get back in the game, but often function better.
View animation of arthroscopy to treat femoroacetabular impingement.
Dancers and others who do repeated twists and turns of the hip sometimes suffer from hip instability, which also can be treated with arthroscopic surgery. In some cases, the hip joint becomes unstable, which causes pain and restricts movement. Through arthroscopy, the doctor tightens the ligaments to fortify the joint.
In younger patients and athletes, arthroscopy is often effective in repairing a tear in the hip cartilage (called the labrum) that is causing pain by "clicking" or "catching." The labrum may be damaged or torn as part of an underlying process, such as FAI or dysplasia (shallow hip socket), or may be injured directly by a traumatic event. Depending on the type of tear, the labrum may be either trimmed (debrided) or repaired.
Inflammation of the Bursa
For middle-aged patients, arthroscopy is more often used to address inflammation of the hip bursa, also known as trochanteric bursitis, greater trochanteric pain syndrome (GTPS) or “rotator cuff tears” of the hip. During arthroscopic surgery, the doctor removes the inflamed bursal tissue and repairs any torn tendons to eliminate the pain.
Pain resulting from mild osteoarthritis can be treated with an arthroscopic procedure, while moderate to severe osteoarthritis may require total hip replacement.
What should the patient do to prepare for hip arthroscopy?
Before scheduling arthroscopy, the patient will meet with one of the Midwest Orthopaedics at Rush hip arthroscopy specialists for an initial consultation to determine whether the patient is a candidate for the procedure. The patient may return for a day of pre-operative screening and education about the procedure. Screening includes a blood test, X-ray, a magnetic resonance imaging (MRI) and CT scan.
The day before surgery, the patient cannot eat anything after midnight. The day of surgery, the patient typically arrives at the Rush SurgiCenter or Rush Oak Park Hospital in the morning. He should arrange for a friend or family member to drive him home after surgery.
Before arthroscopic surgery, the patient and his family should prepare his home for his post-op recovery. Arrange for someone to bring meals and pick up medications from the pharmacy for the first few days after surgery.
If the patient has an upstairs bedroom, it is recommended to arrange for a bed on the first floor temporarily so he does not have to climb stairs. From a medical supply store, he can rent or buy aids including an elevated toilet seat, cane, crutches, walker, shower seat, removable shower hose, long-handled shoe horn and a reacher, which allows him to grab items without bending over.
Set aside a comfortable chair, with a side table and extra pillows, where the patient has easy access to things like a television remote controller, medications and telephone.
What should the patient expect after surgery?
After hip arthroscopy, the patient goes to a recovery room until he wakes up from anesthesia.
Arthroscopy is an outpatient procedure, which means the patient goes home the same day. Two to three weeks post-surgery, he returns to Midwest Orthopaedics at Rush for a check-up with the surgeon.
In most cases, the physician will prescribe over-the-counter pain reliever for four weeks after surgery to manage post-op pain in addition to other medications to prevent blood clots.
The patient should avoid getting his incision wet for four days after surgery and should call the doctor immediately if he has signs of infection, which include chills, fever and drainage from the incision.
Some patients are more comfortable at night if they wedge a pillow between their legs while sleeping. The sooner the patient is able to begin physical therapy after arthroscopy, the better. Physical therapy may be recommended to help the patient recover full range of motion. Most patients enjoy a full recovery from hip arthroscopic surgery in about six months. Athletes can return to their games. The patient returns to Midwest Orthopaedics at Rush for an annual check-up.
What are the risks?
Arthroscopic surgery carries the same risks as conventional surgery, including reactions to anesthesia, hearts attacks and strokes. Complications can include blood clots, pulmonary embolisms, infections, rotation of the leg, bone fractures, blood accumulation in the hips, nerve injuries, numbness, scarring or chronic pain. Excessive blood loss during surgery can lead to an infusion.