Hip Arthroscopy & Hip Preservation
Hip preservation is an expanding field of orthopaedic surgery that focuses on treatment of hip disorders in an effort to maintain a patient’s own hip anatomy, reduce pain, and delay or avoid future need to hip replacement surgery. Hip preservation surgeons like Dr. Dumont focus on non-surgical and surgical methods to achieve these goals. This may include recommendations such as physical therapy for improved function and strength of the hip, injections to improve pain, activity modifications to avoid aggravation of symptoms or injuries, and surgical procedures when necessary.
Some surgical procedures can now be performed arthroscopically through very small incisions. Dr. Dumont specializes in arthroscopic surgery of the hip. There are certain cases that are better treated with open surgery. We strive to help you find the best possible way to improve your hip pain.
Hip arthroscopy is minimally invasive surgery that uses small incisions to access the hip joint, evaluate for existing structural damage or abnormality, and correct damaged structures. Although hip arthroscopy is performed through small incisions, substantial corrective procedures are often undertaken that often require considerable periods of recovery.
The arthroscope is a small instrument consisting of a lens, light source, and high definition video camera. The camera projects an image of the inside of the joint onto a large screen monitor allowing the surgeon to look for any damage, assess the type of injury, and repair the problem.
Various hip conditions can be treated through hip arthroscopy, including:
- Repair a torn labrum: The labrum is a fibrous cartilage ring which lines the acetabular socket.
- Removal of torn cartilage or bone fragments that cause hip pain and mechanical symptoms.
- Correction of irregularly shaped bones including the ball or socket of the hip, that may cause impingement (pinching /pain) in the hip. This condition is known as femoroacetabular impingement.
- Removal of part of inflamed synovium (lining of the joint) in patients with inflammatory arthritis. This procedure is called a partial synovectomy.
- Tightening (plication) of the capsule of the hip in instances where it is noted to be insufficient.
- Repair of torn tendons on the outside of the hip that may cause pain and weakness of the hip. (gluteus medius and gluteus minimus repair), with excision of inflamed bursa tissue surrounding these tears.
- Evaluation and diagnosis of conditions with unexplained pain, swelling, or stiffness in the hip that does not respond to conservative treatment (less common).
Hip arthroscopy is performed under general anesthesia. Traction is required to gradually separate the ball from the socket to allow the instruments to carefully enter the joint.
The surgery usually requires 2 to 4 small incisions about 1 cm in length around the hip joint. The number if incisions may vary based on the type of work that is required. Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and allow clear visualization of the structures in the hip.
The larger image on the television monitor allows visualization of the joint to determine the extent of damage so that it can be surgically treated.
Surgical instruments will be inserted through other small incisions to treat the problem.
After the surgery, the incisions are closed and covered with a bandage. Hip arthroscopy can result in swelling of the hip area and thigh after surgery, but this typically improves within a few days.
The advantages of hip arthroscopy over the traditional open hip surgery includes:
- Smaller incisions
- Reduced trauma to surrounding ligaments, muscles, and tissues
- Excellent visualization of the structures in the joint
- Decreased risk of infection.
- Less scarring
- Earlier mobilization
- Shorter hospital stay (outpatient surgery)
As with any surgery, there are potential risks and complications involved. It is very important that you are informed of these risks before you decide to proceed with arthroscopic hip surgery. Possible risks and complications include:
- Infection at the surgical incision site or in the joint space.
- Nerve damage which may cause numbness, tingling, pain, and weakness.
- Excess bleeding into the joint, a condition called hemarthrosis.
- Blood clots may form inside the deep veins of the legs which can travel to the lungs (pulmonary embolism).
- Bone formation in the muscles and soft tissues around the hip (heterotopic ossification).
- Cartilage injury during surgery.
- Persistent hip pain after your surgery.
After surgery, you should take certain steps / precautions to promote faster recovery and prevent further complications. These include:
- Taking medications as prescribed. These often include:
- Pain medications
- Aspirin (to help reduce the risk of blood clot after surgery)
- Naproxen (to help reduce the risk of heterotopic ossification after surgery)
- Stool softener which can help with constipation that comes with taking pain medications
- Anti-nausea medications if needed.
- Use of an ice machine on the hip area to help with postoperative pain and swelling. This will be applied to your hip after your surgery.
- Use of crutches to limit bearing weight on the operated hip. Dr. Dumont typically recommends a period of 4 weeks partial weight bearing with the use of crutches after arthroscopic hip surgery. You will be given specific instructions after your procedure.
- Physical therapy exercises should be performed to restore normal hip function and improve flexibility and strength. A physical therapy protocol will be provided to you at the time of your operation and should serve as a guide for you and your therapist throughout the recovery period.
- Eating a healthy diet and avoiding smoking will help in faster healing and recovery
- Avoid activity which involves lifting heavy things or strenuous exercises for a period of time after surgery
Limitations of Hip Arthroscopy
With ongoing advances in surgical techniques, arthroscopy plays an important role in diagnosis and treatment of hip disorders. Patients who in previous decades may not have had good options to treat their painful hip now have solutions available to them. Hip arthroscopy is not however for everyone. There are limitations to the types of hip disorders that can be treated. Some conditions that are not amenable to arthroscopy include:
- Hip arthritis
- Hip dysplasia (shallow hip socket)
- Hip pain that may be a result of nerve compression in the spine.
Dr. Dumont will perform a thorough evaluation of your hip which includes a listening to your description of symptoms, a physical examination, and evaluation of imaging of your hip to discuss with you whether or not you may be a candidate for arthroscopic hip surgery. In some cases arthroscopic surgery is not an option, and we will carefully review options we feel may be best for your hip, and help guide you in the right direction to receive the best possible care.