Hip arthroscopy: Procedure and recovery

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Following a hip pain persistent, diagnostic tests may not be specific enough to clearly identify the source of the problem. In this case, some doctors will opt for hip arthroscopy to explore the joint with a camera via minimally invasive surgery.

What is a hip arthroscopy, and what are the indications? How does the procedure take place ? Does this procedure present any risks and complications? And is the prognosis favourable? This popular article explains everything you need to know about this operation.

Definition

Hip arthroscopy has been performed for many years, although it is not as common as knee or shoulder arthroscopy.

This is a surgical procedure that allows doctors to view the hip joint without making a large incision through the skin. Using a small intra-articular camera, several common hip problems can be diagnosed.

Because the incision is minimal, patients generally experience less post-surgical pain and stiffness, and recovery time is shorter, as is the return to daily activities and sports.

Anatomy reminder

Before going into the details related to hip arthroscopy, it is important to understand the anatomy of this joint.

The hip is one of the largest joints in the body. It connects the pelvic bone (via a cavity called the acetabulum) and the femoral head (the upper part of the thigh bone).

The bony surfaces of the femoral head and acetabulum are covered with articular cartilage, a substance that allows shock absorption and frictionless movement of the bones against each other.

The surface of the joint is also covered with a thin membrane called synovia. In a healthy hip, the synovium produces a small amount of sufficient fluid that lubricates the cartilage and facilitates movement.

A fibrocartilage called the labrum surrounds the acetabulum and provides the hip with its stability. Ligaments surrounding the joint form a capsule and also help hold the hip in place.

Indications

Your doctor may recommend hip arthroscopy is prescribed by the doctor for patients who suffer from a painful condition of the hip that does not respond to non-surgical treatment. This generally includes rest, medication, kinesitherapy (physiotherapy) and possibly injections.

Essentially, hip arthroscopy can relieve painful symptoms of many problems affecting the labrum, cartilage, or other soft tissues surrounding the hip joint. These conditions can result from trauma or overuse injury such as:

  • Le femoroacetabular impingement (CFA):  This is a disorder where a bony growth develops along the acetabulum and/or on the femoral head. This can irritate the soft tissues of the hip during movement.
  • hip dysplasia 
  • Snapping hip syndrome: This condition causes tendon rubbing on the outer part of the hip, sometimes causing a popping sound. The latter is not necessarily problematic at all times, but can irritate the tendon by repeated friction in some cases.
  • Synovitis: It causes inflammation of the tissues that surround the hip joint.
  • Foreign bodies: These are fragments of bone or cartilage that move and can get stuck in the coxo-femoral joint.
  • A infection of the hip joint

Procedure

Preparation and admission

In addition to the indications related to hip arthroscopy, the attending physician must ensure the patient's general state of health before surgery. If the latter constitutes a health risk, further evaluations will have to be carried out before obtaining the green light from the surgeon.

If the patient is in good general health, the operation will generally be carried out in the operating room, and it will be possible to leave the hospital the same day. Individual instructions will be given (taking medication, fasting, abstaining from liquids, etc.) on a case-by-case basis.

Anesthesia

Prior to the operation, the patient will be assessed by a doctor who specializes in anesthesia. Hip arthroscopy is most often performed under general anesthesia, meaning the patient will be asleep during the operation.

Alternatively, regional anesthesia such as spinal anesthesia or epidural can also be used. This type of anesthesia keeps the patient awake. With regional anesthesia you are awake but your body is numb from the waist down. Your orthopedic surgeon and anesthesiologist will discuss with you which method is best for you.

Surgical intervention

At the beginning of the surgery, the leg will be put in traction. This will allow the surgeon to better visualize the coxo-femoral joint, and to insert his instruments there in order to carry out the necessary interventions.

A small puncture will then be made at the hip (about the size of a buttonhole), and a camera will be inserted. This will make it possible to visualize the interior of the joint, and identify the damaged structures and potentially responsible for the pain. Images will be projected on a video screen to clarify the diagnosis.

Once the problem is clearly identified, the surgeon can then make other incisions and insert other instruments aimed at correcting the affected structures. Possible interventions during hip arthroscopy include:

  • Cartilage repair by “smoothing” its surface
  • Correction of osteophytes (bone spurs) caused by osteoarthritis
  • Removal of inflamed synovial tissue
  • Etc

The duration of the procedure depends on what the surgeon identifies as problems, and the amount of work to be done. At the end of the procedure, the arthroscopic incisions are usually sutured or covered with skin strips. An absorbent dressing is finally applied to the hip.

Risks and complications

Complications of hip arthroscopy are rare. Nevertheless, any surgery in the hip region carries risks such as:

  • Nerve irritation (temporary numbness)
  • Injury to surrounding blood vessels
  • Infection
  • Deep vein thrombosis

Recovery and recovery

After the operation, the patient is typically directed to a recovery room where there is 1 to 2 hours before being allowed to go home. A driver is recommended for the return trip home, and it is not uncommon to have to resort to crutches for some time.

Pain management

To manage post-operative pain, the doctor will prescribe medication. This is a normal phase and part of the healing process. Analgesics and/or anti-inflammatories will help control symptoms and recover more quickly from surgery. Rarely, opioids will be indicated to relieve significant pain (beware of the risk of addiction).

Besides medication to control pain, the doctor may also prescribe medication to reduce the risk of blood clots forming leading to deep vein thrombosis.

Re-education

Ideally, a physiotherapist (physiotherapist) will follow up after the hip arthroscopy. This will allow the patient to relieve their symptoms, in addition to resuming their professional and sports activities in an optimal way. Modalities used in physiotherapy include:

  • Analgesic modalities (ice, heat, electrotherapy, etc.) aimed at reducing pain
  • Massage and mobilizations aimed at relaxing tense muscles and improving hip mobility
  • Therapeutic exercises aimed at avoiding the risk of atrophy, and allowing the resumption of activities
  • Walking rehabilitation (initially with crutches, then without technical aids)
  • Daily education and advice
  • Etc

Prognosis

Many people return to full activity after arthroscopy. Obviously, recovery will depend on the type of lesion present, the general condition of the patient, and the severity of the symptoms. In some rare cases, the intervention is unsuccessful due to irreversible damage to the hip.

Sometimes lifestyle changes will be necessary to avoid worsening the condition and allow for optimal recovery. For example, some athletes will have to reduce the impact on their joints, or even avoid positions that exert excessive stress on the coxo-femoral joint.

These decisions will be tailored to each individual, and should be discussed with the surgeon and physical therapist (physiotherapist).

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