Hip Arthroscopy

This booklet gives you information about hip arthroscopy. It will explain what will happen when you come into hospital, what to expect before you go home and when you are at home. The success of the operation is a team effort including doctors, nurses, physiotherapists but most importantly you.

Please note that your aftercare and rehabilitation will vary depending on what you have done to your hip during the operation and also on your surgeon’s wishes.

Next: Who may be suitable for a hip arthroscopy?

A hip arthroscopy is a surgical procedure where we look inside the hip joint using a small camera on the end of a flexible tube (an arthroscope). This allows the surgeon to see any problems in the hip joint. The surgeon can then use small instruments to treat some of these problems if appropriate. Hip arthroscopy can help with the following problems:

• Labral tears

• Hip impingement

• Damaged cartilage

• Loose bodies in the joint

Next: What to expect

The Operation:

You will have a general anaesthetic which means you will be asleep. The operation usually takes 1 to 2 hours. We use a special table to access your hip joint. This moves the joint a little further apart and allows space to insert the arthroscope. The surgeon will make 2 to 4 small cuts around your hip area. They will insert the arthroscope and any instruments needed to treat your hip through these cuts.

The Wound:

Sometimes we stitch the cuts but not always. We will cover them with a sterile dressing. Usually the nursing staff change this dressing if you stay in overnight, however if it is dry and intact they may leave it. We will give you dressings to take home with you. The nursing staff will discuss this with you on the ward.

Pain Control:

We will inject some local anaesthetic into the joint and around your cuts to help reduce the pain when you wake up. We will also give you pain killers. It is important to let a member of staff know if you are sore so they can give you something to help.

Discharge (Going Home):

Most patients go home the day after their operation but some people go home the same day. This depends what time you are back on the ward and how you are feeling.

Next: Complications

After a hip arthroscopy it is likely that you will have some muscle bruising and swelling around the hip and thigh. As with any surgical procedure there is a small risk of other complications. These may include:

1.  Difficulty passing urine or having a bowel movement after the operation.
2.  Problems with the anaesthetic or development of an acute medical problem (clarify).
3.  Wound Infections: If you notice a change in the area around your wounds and they become red, very hot and swollen, or if you develop any discharge from your wounds please see your GP as soon as possible?
4. Blood clots in your calf are known as a DVT (deep vein thrombosis):

• You may go home on aspirin to help prevent this however the best way to reduce the risk is to do the exercises in this booklet regularly and by moving around.

• If you experience pain and tenderness in your calf and it becomes hot and swollen please see your GP.

    5. Blood clots in your lung known as a PE (pulmonary embolis):

• If you experience a sudden shortness of breath which is unusual for you please see your GP.

    6. Damage or bruising to a minor nerve leading to numbness or tingling in your thigh, groin or genitalia.

    7. Damage to the major blood vessels or nerves around the joint or the joint itself.

Next: Physiotherapy

You will normally see a physiotherapist before you go home. They will show you some exercises to help keep the muscles around your hip strong and to get the hip moving. These exercises are shown in this booklet.

We will give you elbow crutches to help you walk after the operation. You may be able to take as much weight as you feel able to through your hip (fully weight bearing) but we will often advise you to take some weight off the hip by leaning through the elbow crutches (partial weight bearing). This will depend on what treatment you have done and on your consultant’s wishes. For example if you have a simple labral tidy up you will usually be able to fully weight bear. However if you have a more extensive procedure such as microfracture on your joint surface we will normally advise you to take minimal weight through your hip for 4-6 weeks. The physiotherapist will advise you how much weight to take through your hip and how long you will need to use your elbow crutches.

We will show you how to go up and down stairs before you go home.

Your physiotherapist is likely to refer you to your local physiotherapy department for ongoing rehabilitation and in some places they may refer you for hydrotherapy (rehabilitation in water). This will depend on where you stay and on your consultant’s wishes.

Next: Exercises

1. Ankle pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and helps prevent clots forming.

2. Static Quads: Point your toes to the ceiling. Press the back of our knee against the bed tightening up the muscle at the front of your thigh. Hold for 5 seconds then relax. Repeat 10 times.

3. Static Gluts: Squeeze your bottom muscles together. Hold for 5 seconds then relax. Repeat 10 times.

4. Static Hamstrings. Dig your heel into the bed as if trying to bend your knee. Hold for 5 seconds then relax. Repeat 10 times.

5. Hip Flexion: Bend your hip and knee up and down. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg up. Do 2 sets of 10.

Following some procedures this movement may be restricted for 4-6 weeks. Your physiotherapist will advise you if this is the case.

6. Hip Abduction: Bring your leg out to the side then back in again. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg out to the side and back in. Do 2 sets of 10.

It is important to do these exercises regularly. We advise you to try and do them 4 times a day or even a set of 10 every hour or two.

 Next: Going Up and Down Stairs

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up the stairs as you will need it when you get to the top.

Going up stairs:

1. Place your un-operated leg up onto the step

2. Lift your operated leg onto the same step

3. Bring the crutch up onto the same step

Going down the stairs:

1. Place your crutch down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

 Next: General Advice Following your Hip Arthroscopy

Ice:

This may help with pain and swelling around the hip or thigh area. Wrap an ice pack or a bag of frozen peas in a towel and rest this on your hip or thigh area. Do not leave on for any longer than 20 minutes at a time.

Pain Relief:

We will usually give you a 7 day supply of pain killers to take home with you and can get more from your GP if necessary once these run out. If you experience more pain when you go home and do not feel the pain killers are helping, please see your GP.

Wound Care:

If you have stitches you will need to visit your practice nurse 10-12 days after your operation to have these removed. The nursing staff will discuss your wound care with you before going home.

Rehabilitation:

It is important to do the exercises in this booklet regularly to prevent your hip becoming stiff and weak. Most patients are referred for physiotherapy locally once they are home. The length of time you need to go to physiotherapy will depend on the treatment that you have and also on what activities you plan on getting back to. You are likely to attend physiotherapy for at least 3 months.

Next: Return to Activity

• Driving: You can begin driving when you are allowed to be fully weight bearing, walking without crutches and feel comfortable to do so. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. This will vary depending on what treatment you have and on your consultant’s wishes.
•  Work: This will depend on your job and on what treatment you have done. People in manual jobs or jobs involving a lot of walking are likely to need longer off than those who have jobs involving mainly sitting. Please discuss this with your consultant while in the hospital or in the clinic
•  Sport: Your physiotherapist will advise you about returning to sport. Again this will depend on what treatment you have done and on the sport you wish to return to.

Next: Routine Follow-Up

We will see you back at the clinic 4-6 weeks after your operation. You may then have a further appointment about 12 weeks after the operation. If you need further appointments we will arrange these.