Hip Arthroscopy
Injuries or conditions that damage the ligaments, bone, cartilage, and other soft tissues surrounding the hip joint can frequently be repaired with minimally-invasive hip arthroscopy, or a “hip scope.” Dr. Geoffrey Van Thiel is a nationally recognized expert in the field of hip arthroscopy and has performed hundreds of procedures on patients from recreational to high-level athletes. The best candidates for this procedure are active individuals who have not yet suffered from significant cartilage loss or arthritis. Hip arthroscopy utilizes 2-3 incisions ¼-1/2 inch long rather than a more tradition and invasive “open” surgery requiring a much larger incision. An arthroscope, or long thin camera, is inserted into one of these small incisions to allow the surgeon to view inside the joint area while using other surgical instruments inserted through a separate incision or incisions to smooth or repair the cartilage, trim bone spurs, repair the hip labrum, or remove inflamed tissue that may be causing the problem.
Hip arthroscopy is typically an out-patient procedure performed while the patient is asleep under general anesthesia. While there is a very small risk of infection or blood clots forming in the legs, complications from hip arthroscopy are uncommon. Following initial rest, physical therapy and special exercises to restore strength and mobility are important to achieve the best recovery.
The management of patients with hip pain requires complex decision making and innovative treatment from a team of nurses, surgeons, and therapists. Multiple studies demonstrate a significant learning curve for hip arthroscopy with more experienced surgeons having shorter operative times, fewer complications, and better results. The Hip Arthroscopy Center has a dedicated team, led by Dr. Van Thiel, who has performed hundreds of hip arthroscopy procedures and is committed to getting you back to your lifestyle.
Benefits of less-invasive hip arthroscopy include:
- Out-patient procedure
- Smaller incisions
- Earlier rehabilitation
- Earlier return to activity
Hip arthroscopy may relieve the painful symptoms of:
Is Hip Arthroscopy for you?
Hip arthroscopy is an excellent option for patients with labral tears, impingement, gluteus medius tears, bursitis, among other hip conditions. However, the initial treatment of hip pain does not always require surgery. For active people with hip problems, a course of rest, physical therapy, medication, and possibly injections may relieve the discomfort and can provide a full return to all activities.
How do you know if you have a hip problem?
A combination of physical and diagnostic exams are used to determine if a patient is suitable for hip arthroscopy. Pain in the groin or on the outside of the hip are “classic” locations for pain due to a hip issue. Longstanding pain may also be a sign that something is wrong. Advanced imaging such as xray, MRI and CT scans provide important information that helps formulate a specific diagnosis. The good news for patients that choose to undergo hip arthroscopy is that studies have shown that 85-90% of hip arthroscopy patients return to sports and other physical activities at the level they were at before their onset of hip pain and disability
Hip anatomy
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other.
The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket. The joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. The undersurface of the capsule is lined by a thin membrane called the synovium. It produces synovial fluid that lubricates the hip joint.
In a healthy hip, the femoral head fits perfectly into the acetabulum.
Planning for hip surgery
Your hip arthroscopy will most likely be performed as an outpatient procedure. This means you will not need to stay overnight at the hospital. The hospital or surgery center will contact you ahead of time to provide specific details of your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your procedure.
Before the operation, you will also be evaluated by a member of the anesthesia team. Hip arthroscopy is most commonly performed under general anesthesia, where you go to sleep for the operation. Regional anesthesia can also be used to help with the post-operative pain control.
Surgical hip procedure
At the start of the procedure, your leg will be put in traction. This means that your hip will be pulled away from the socket enough for your surgeon to insert instruments, see the entire joint, and perform the treatments needed.
After traction is applied, your surgeon will make a small puncture in your hip (about the size of a buttonhole) for the arthroscope. Through the arthroscope, Dr. Van Thiel can view the inside of your hip and identify damage.
Dr. Van Thiel will insert other instruments through separate incisions to treat the problem. A range of procedures can be done, depending on your needs. For example:
- Smooth off torn cartilage or repair it
- Trim bone spurs caused by FAI
- Remove inflamed synovial tissue
- Repair the labrum
The length of the procedure will depend on what Dr. Van Thiel finds and the amount of work to be done.
Complications
Complications from hip arthroscopy are uncommon. Any surgery in the hip joint carries a small risk of injury to the surrounding nerves or vessels, or the joint itself. The traction needed for the procedure can stretch nerves and cause numbness, but this is usually temporary. There are also small risks of infection, as well as blood clots forming in the legs (deep vein thrombosis).
Recovery
After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. You will need someone to drive you home and stay with you at least the first night. You can also expect to be on crutches for some period of time.
Rehabilitation
Dr. Van Thiel will develop a rehabilitation plan based on the surgical procedures you required. In most cases, physical therapy is necessary to achieve the best recovery. Specific exercises to restore your strength and mobility are important. Your therapist can also guide you with additional do’s and dont’s during your rehabilitation.
Long term outcomes
Many people return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your hip. For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). These are decisions you will make with the guidance of Dr. Van Thiel.
Co-developed by the American Orthopaedic Society for Sports Medicine