- 1 What is a Hip Arthroscopy?
- 2 What is the hip arthroscopy process like?
- 3 When is hip arthroscopy recommended?
- 4 What are the benefits of hip arthroscopy?
- 5 What are the Advantages of Hip Arthroscopy Over Open Surgery?
- 6 What is post-op and recovery like?
- 7 When is it okay for me to go back to sports?
- 8 What is the long-term outcome of hip arthroscopy?
- 9 How do you choose an orthopaedic surgeon for hip arthroscopy?
- 10 Dr Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance
Hip pain is a common health complaint every year that stems from a variety of causes. Back in the day, these issues can be addressed with open surgery. But as the practice evolved, hip concerns can now be addressed using conservative treatments. Cortisone shots and physical therapy are some of the common interventions, but with complex structural issues, a hip arthroscopy is increasingly preferred for certain patients.
When persistent pain interferes with your daily life and remains unresolved with other treatments, you may need surgery. If you prefer a conservative approach, we’ve answered frequently asked questions about this treatment to help you get started.
What is a Hip Arthroscopy?
Hip Arthroscopy is a minimally invasive outpatient procedure that uses a flexible fiber-optic tube with a small camera (arthroscope) that is connected to a monitor. It is used to treat painful hip conditions that were traditionally repaired through larger open incisions.
Arthroscopy is usually done on joints like the knee and shoulder, but developments made it possible for surgeons to safely access the hip as well. What’s tricky about the hip joint is that it’s located deeply with a high congruity compared to the knee and shoulder joints. It’s difficult to get into the hip using an arthroscope because it’s a tightly constrained ball-and-socket joint. So for years, there wasn’t much that could be done.
However, with recent techniques, the availability of instruments and appropriate surgical beds, orthopaedic surgeons can already work within the hip safely. It’s now possible to access this difficult area using a smaller incision, which in the past, was reserved only for the knee and shoulder.
What is the hip arthroscopy process like?
An arthroscope is made up of a thin tube, a lens, and a light source. A small surgical cut is needed to insert this instrument into the hip. Through it the surgeon can visualise the hip joint to check for damage or disease.
There’s not a lot of room to maneuver an instrument inside the hip. So to operate on the hip safely, traction is used to pull on the patient’s leg to bring the hip out enough and get the arthroscope in. Instead of a typical surgical bed, hip arthroscopy is done on a traction table for proper positioning and efficient access to the deep-seated hip joint.
This customised surgical bed comes with a boot that applies traction to the foot which separates the ball and socket of the hip joint. Patients can either lie on their chest or placed in a side-lying position during the procedure.
Once the arthroscope placement is confirmed, the surgical team will make two to three small puncture wounds on the side of the hip that are just about the size of a buttonhole. This access allows the surgeon to visualise the joint and check for loose bodies, cartilage injuries, or ligamentous injuries. Once the problem is identified, the team can now proceed with the appropriate treatment.
Hip arthroscopy is commonly an outpatient surgery done in a centre or hospital. But there are cases where surgical time can be quite prolonged, so an overnight stay may be considered.
When is hip arthroscopy recommended?
- labral tears
- removal of loose bone or cartilage fragments within the hip joint
- hip impingement/ femoroacetabular impingement
- snapping hip
- articular cartilage injuries
- synovial disease
- hip pain
- septic arthritis
- chondral defects
- ligamentum teres injury
- AIIS subspine impingement
- capsular tears or instability
- iliopsoas tendon pathology
- gluteal tears
- trochanteric bursal debridement
- ischiofemoral impingement
- deep gluteal syndrome
- piriformis debridement/release
- proximal hamstring tears
Conversely, hip arthroscopy is contraindicated in patients with the following conditions:
- pre-existing arthritis
- regional pain syndromes (e.g. RSD, fibromyalgia).
- advanced degenerative joint disease
- hip ankylosis
- severe dysplasia
- joint contracture
- severe osteoporotic bone
- significant protrusio acetabuli
What are the benefits of hip arthroscopy?
Hip arthroscopy is a procedure that can help reshape the bones in your hip joint. It can alleviate pain and discomfort by removing torn cartilage, excess bone growth, or inflamed tissue. Furthermore, it can also repair tears and fractures.
Check out the video below for a quick look at the list of benefits under hip arthroscopy.
What are the Advantages of Hip Arthroscopy Over Open Surgery?
Hip arthroscopy provides a minimally invasive option for surgeons to address issues within a delicate joint. Dr Dutton explains that “As there are numerous muscles surrounding the hip joint, open surgery would involve large incisions and the muscles would have to be cut.”
With hip arthroscopy, what would previously require invasive open surgical treatment can now be done conservatively. The procedure promotes hip preservation because it allows orthopaedic surgeons to preemptively treat degenerative conditions like arthritis. By delaying the onset of hip arthritis, the need for hip replacement in the future can be delayed or eliminated. All these can be possible even without causing so much trauma to the hip.
However, even though the effectiveness of hip arthroscopy is comparable to that of open surgery, it doesn’t mean that the minimally invasive option can replace the latter. There are complex cases that may not be accessible with arthroscopic techniques. Hence, an open procedure is considered because it enables the surgeon to have wider exposure. In these cases, surgical approach decisions must be based on the structural deformity or injury characteristics and a technique’s capacity to surgically correct it.
So, it’s not a question about which one is a better option, it’s about choosing what is appropriate for the case at hand.
What is post-op and recovery like?
Generally, patients should be able to walk with crutches immediately after surgery with partial weight-bearing, or with your foot flat on the ground as you walk.
Prior to discharge patients are given written discharge instructions and a prescription for therapy. Physical therapy can significantly influence your recovery. A formal physical therapy program is quite beneficial and, in some cases, it can begin the day after surgery. However, take note that rehab protocols will vary by procedure and surgeon.
It will be a series of specific exercises to restore your strength and mobility for the next few weeks. The therapist will also provide activity requirements and restrictions.
When is it okay for me to go back to sports?
With input from your rehab provider, your surgeon will determine when it will be safe for you to get back in the game.
Your pain, strength, and range of motion will be checked to see if these are progressing at an appropriate rate. Typically, patients are allowed to have full, unrestricted activity anywhere between 4-6 months after surgery.
What is the long-term outcome of hip arthroscopy?
Many people return to full, unrestricted activities after arthroscopy. However, recovery will depend on the type of damage that was sustained by the hip.
Some people may have to adopt some lifestyle changes to protect the joint. For instance, instead of the usual high-impact exercise like running, they may have to switch to lower impact activities like swimming or cycling. These decisions will be made along with the guidance of your surgeon.
Your condition at the time of surgery can also influence the outcome. Your injury may be the same as that of a professional athlete, but recovery may not be as speedy or complete. The reason is that professional athletes are likely to have stronger muscles around the knee.
In some cases, the damage is severe enough that it can’t be completely reversed and the procedure may not be successful.
How do you choose an orthopaedic surgeon for hip arthroscopy?
While any orthopaedic surgeon can do arthroscopic surgery, not everyone is specialised in scoping the hip.
As mentioned earlier, hip arthroscopy is a recent addition to the list of joint arthroscopic procedures. Since the hip is a complex joint there are a lot of considerations that must be made, such as the right tools, techniques, positioning, and even the right surgical bed. There are approaches specific to the hip where a surgeon’s training is critical in preventing injuries during operations and ensuring surgical success.
So when you seek help for hip joint pain, take the extra step of finding yourself an orthopaedic surgeon who specialises in hip surgeries.
If you are in Singapore and have been struggling with hip pain or any related issues, you can consult Dr Andrew Dutton and get a thorough evaluation. He holds clinical interests in arthroscopic or keyhole surgery of the knee, hip and shoulder. He also completed subspecialty training in complex surgeries of the hip and knee during his time in Massachusetts General Hospital and Harvard Medical School, Boston, USA. You can call us today at (+65) 6836 8000 for an appointment.