Hip arthroscopy is a medical procedure that allows orthopedic specialists to view the hip joint without the need for a large incision through soft tissues, like skin. There are many uses for arthroscopy of the hip ranging from diagnosis to treatment. At Plymouth Bay Orthopedic Associates in Plymouth, MA, we don’t believe in performing invasive procedures when there are safer, more effective options.
1. How Long Does Hip Arthroscopy Take?
If your primary care physician has recommended you undergo hip arthroscopy, you probably have a lot of questions. To answer the most common question we get about this procedure, arthroscopy of the hip takes between 90 and 120 minutes depending on why the procedure is being performed.
2. What Is the Anatomy of the Hip?
The hip is known as a ball and socket joint. Formed by the acetabulum, the socket is part of the large pelvis bone. The ball consists of the upper end of the thighbone, also known as the femoral head. The surface of the ball and socket are covered by a slippery tissue known as articular cartilage. This cartilage provides a smooth, frictionless surface so your bones can glide across each other easily.
The acetabulum is surrounded by the labrum, which is an extremely tough fibrocartilage. This forms a gasket around the socket. Surrounding the joint is bands of tissue known as ligaments. Ligaments form a capsule to hold the joint together. Beneath the surface of this capsule is a thin membrane lining known as the synovium. It lubricates the hip joint by producing synovial fluid.
3. When Is Arthroscopy of the Hip Recommended?
Hip arthroscopy is most often recommended because a client has extreme hip pain that has not responded to nonsurgical treatment. Such “conventional” therapies often include physical therapy, rest, anti-inflammatory medications and anti-inflammatory injections. Besides injury, several orthopedic conditions can lead to damage of the articular cartilage, labrum and other soft tissues encasing the joint. Such conditions include:
- Femoroacetabular impingement (FAI)
- Dysplasia
- Snapping hip syndrome
- Synovitis
- Loose bodies
- Hip joint infection
4. What Is FAI?
FAI is a disorder characterized by extra bone developing on the femoral head (cam impingement) or acetabulum (pincer impingement). This overgrowth of bone is known as a spur and damages the hip’s soft tissues when the joint moves. In some cases, bone spurs can develop in both the femoral head and acetabulum.
One or both hips may be affected by this condition. Arthroscopy is often recommended to treat femoroacetabular impingement because it allows the orthopedic surgeon to trim off the excess bone without the need for extensive incisions.
5. What Is Dysplasia?
Dysplasia is an orthopedic condition characterized by an abnormally shallow hip socket. To keep your femoral head inside its socket, extreme painful pressure is placed on the labrum. Due to this pressure, the labrum is particularly susceptible to tearing.
6. What Is Snapping Hip Syndrome?
Snapping hip syndrome is an orthopedic condition that causes tendons to rub across the outside of the joints. In most cases, this type of popping or snapping is harmless and does not require treatment. However, over time, the tendon can become severely damaged from repeated rubbing.
7. How Should I Prepare for the Procedure?
To prepare for arthroscopy, you will first need to visit your primary care physician to assess your general health. This is to ensure you are healthy enough to undergo the procedure. He or she is very familiar with your medical history and can identify any problems or conditions that may exclude you from the procedure. If you exhibit certain risk factors, you may need a more extensive evaluation before we can recommend this procedure to you.
8. What Happens Next?
During your initial consultation, you will be advised on what to expect before, during and after your procedure. Bring a comprehensive list of all medications and supplements you are currently taking. You may need to stop taking these during the weeks or days leading up to your procedure.
The most important instructions to follow are those related to when you must stop eating and drinking before your procedure. Any food or water in your stomach can affect the anesthesia.
9. What Type of Anesthesia Is Used?
Before your arthroscopy, you will be evaluated by a member of our expert anesthesia team. If your heart and lungs are healthy enough, we strongly recommend that you choose general anesthesia. Even with general anesthesia, however, this is still an outpatient procedure, and you are free to go home on the same day. You can’t drive within 24 hours of being put under general anesthesia, so you will need to arrange for a ride to and from our state-of-the-art facility.
If you don’t like the idea of being put under general anesthesia, you may opt to receive regional anesthesia, such as epidural anesthesia or spinal anesthesia. With regional anesthesia, you will remain awake throughout your entire procedure but you will not be able to feel anything from the waist down.
10. How Is the Procedure Performed?
When the procedure begins, your leg will be put in traction. In other words, your orthopedic surgeon will pull the hip away from the socket just enough to insert his instruments, see the entire joint and perform any treatment necessary. Typically, your surgeon will draw lines on your hip to indicate where the bone, blood vessels and nerves in your hip. These lines are also used to guide the insertion of the portals for the arthroscope.
11. What Can I Expect During the Procedure?
Once traction has been applied, your surgeon will make a tiny puncture in your hip to accommodate the arthroscope. Through this device, he can see inside your hip and identify what is causing the pain and damage. To maintain a clear view of the inside of the hip, fluid flows through the arthroscope.
The images transmitted from the arthroscope are projected on a video screen for your orthopedic surgeon to view. Before beginning a particular treatment, your surgeon will evaluate the joint.
Once it is clear what the problem is, your surgeon will repair the hip with other small instruments inserted into the pinhole. Depending on your unique needs, there are several procedures which can be performed through this pinhole. For example, inflamed synovial tissue can be removed. Bone spurs caused by FAI can be trimmed. Torn cartilage can be smoothed off or repaired.
12. What Can I Expect After the Procedure?
After your procedure, you will be observed in our recovery room for an hour or two. After that, you are free to go home. Arrange for someone to stay with you for at least the first 24 hours post-op. This way, you can focus all your attention and energy on resting.
13. What Can I Expect During Recovery?
Your orthopedic surgeon will work closely with you to develop a rehabilitation plan. This will be based largely on the particular treatment you received. In nearly all cases, clients work with a physical therapist. During recovery, it is essential that you practice certain exercises to restore your mobility and functional strength. Your physical therapist will help you recover quickly and comfortably so you can get back to your strong, confident, pain-free life.
14. What Can I Expect in the Long Term?
After your arthroscopy and subsequent recovery, you can return to full, unrestricted activities. However, depending on your unique situation, you may need to make certain lifestyle changes to protect your joint from future damage. For example, for the health of your hip, you may need to trade a high impact exercise like running for a low impact exercise like cycling or swimming.
15. How Does Arthroscopy Compare to Traditional Hip Surgery?
Tissue Damage
There is no muscle damage associated with arthroscopy. Traditional hip surgery requires an incision measuring between 10 and 12 inches long. Arthroscopy only requires two to three pinholes, each measuring a centimeter across. Second, traditional hip surgery involves removing muscles and tendons from the bones. Moreover, the femoral head must be dislocated from the hip socket to allow the surgeon to view the joint completely.
Contrastingly, the pinholes for arthroscopy are made of the front side of the hip where there is drastically less muscle tissue. Finally, no tissue needs to be cut or removed to view or access the joint because the highly specialized instruments can work between tissue.
Recovery
Recovering from arthroscopy is completely different from recovering from traditional hip surgery. First, traditional hip surgery requires a 24-hour hospital stay for observation. We only observe our clients for an hour or two post-op to ensure enough of the effects of anesthesia have worn off.
Second, people who undergo traditional hip surgery cannot bear their body weight for eight weeks post-op. Contrastingly, when arthroscopy is used to remove foreign bodies or torn pieces from the hip, clients can place their full body weight on the joint after only two or three days. Moreover, clients who received arthroscopy to repair the joint’s anatomical structures can resume all regular activities after only three or four weeks.
17. Am I a Good Candidate for Arthroscopy of the Hip?
If you are between the ages of 18 and 65, there is an excellent chance that you are a good candidate for arthroscopy of the hip. This is particularly true if your orthopedic condition has not been diagnosed. Alternatively, you may be an excellent candidate for this procedure if you have been diagnosed with a condition but your pain does not respond to conventional therapies.
The best candidate for this procedure has significantly impaired mobility or extreme pain which prevents them from living life to the fullest. This diminished quality of life is usually caused by FAI, a labral tear that may or may not be related to the FAI, loose bodies in the hip region, or hip dysplasia. Young, healthy individuals are the best candidates for this procedure because the hip joint is located deep inside the body and younger people tend to have less tissue surrounding the joint.
18. Who Is Not a Good Candidate for Arthroscopy of the Hip?
Unfortunately, not everyone is a good candidate for arthroscopy of the hip. For example, if you suffer from moderate-to-severe arthritis, you are a better candidate for a partial or total hip replacement. If you are not a good candidate for this procedure, one of our orthopedic surgeons will work closely with you to devise a treatment plan which will actually give you your quality of life back.
19. What Is a Minimally Invasive Hip Replacement?
A minimally invasive hip replacement is a procedure involving a tiny incision made over the outside region of the hip. During this procedure, the tendons and muscles in the hip area are detached. Once the prosthetic hip has been put into place, the muscles and tendons are reattached.
20. How Does a Minimally Invasive Hip Replacement Compare to a Hip Replacement?
A minimally invasive hip replacement has many advantages over a traditional hip replacement. First, a traditional hip replacement requires an incision of five to 10 inches along the side of the hip. Contrastingly, the minimally invasive approach requires incisions that are shorter than two inches.
Moreover, the recovery time required for a traditional hip replacement is twice as long as the recovery time required for a minimally invasive hip replacement.
21. Is a Minimally Invasive Hip Replacement Right for Me?
A minimally invasive hip replacement may be right for you if you suffer from osteoarthritis of the hip, or if you regularly experience joint pain as well as swelling, discomfort and stiffness. These side effects of osteoarthritis make walking, climbing stairs and sitting for longer than half an hour at a time difficult. You may also be a good candidate for this procedure if you suffer from an autoimmune disease, such as lupus, which causes the immune system to attack the joint cartilage.
A hip replacement may also be required if you suffer from avascular necrosis, a condition characterized by dying bones and the destruction of cartilage. Rheumatoid arthritis may cause you to need a minimally invasive hip replacement if the joint inflammation is severe or your cartilage has eroded. Finally, traumatic injuries often lead to degenerative joint disease and require a hip replacement for correction.
22. Is Hip Labrum Repair an Effective Alternative to Arthroscopy of the Hip?
In most cases, hip labrum repair is performed in conjunction with arthroscopy of the hip. This minimally invasive procedure repairs torn labral tissue. Labral tissue tears can be caused by the progression of osteoarthritis of the hip or a hip injury. Depending on the type of labral tear you have, you may also need debridement.
23. How Is a Hip Labrum Repair Performed?
Hip labrum repair starts by pulling the hip just far enough away from the acetabulum that your orthopedic surgeon can see inside your hip and insert the specially designed surgical instruments required to repair the tear. Then, tiny punctures are carefully made and the instruments are inserted so the tear can be repaired. Depending on your unique case, inflamed tissue may also need to be removed.
Learn More About Joint Care Today
Sometimes hip pain cannot be eased by medications, rest and physical therapy. An orthopedic condition needs to be diagnosed. Excess bone needs to be trimmed away. But you don’t need to undergo an invasive orthopedic procedure to enjoy relief. To learn more about hip arthroscopy or find out if it’s right for you, contact us at Plymouth Bay Orthopedic Associates in Plymouth, MA today to schedule your initial consultation.