Hip Arthroscopy Video
Labral Tear of the Hip (Acetabular Labrum Tear)
Introduction
What is a hip arthroscopy?
A hip arthroscopy is a minimally invasive procedure whereby 2 or 3 small incisions are made around the hip and camera inserted to visualise the inside of the hip joint. This enables many conditions inside the hip to be treated and gives a better view of the joint than traditional open procedures.
What are indications for a hip arthroscopy?
- Labral tears
- Removal of loose bodies
- Biopsy of lesions
- Synovectomy
- Diagnosis of pain
- Infection
CONTRAINDICATIONS
- Advanced arthritis
- Stiff hip
- Heterotopic ossification
- Severe dysplasia
Pre-Operation
- 10 days prior to surgery, cease aspirin and anti-inflammatory medications (e.g. Voltaren, Feldene) as they may cause bleeding.
- 10 days prior to surgery cease any naturopathic or herbal medications as these may also cause bleeding.
- Continue with all other medications unless otherwise specified
- Notify Dr Walker if you have any abrasions, cuts or pimples around the knee.
- Bring any X-rays, MRI scans or other investigations you have had done which may be relevant to your surgery.
Procedure
- Under anaesthetic you are positioned on a special operating table with your legs strapped into boots to allow traction to be put on the hip. X-ray control is then used to mark out the landmarks used for surgery.
- The hip is distracted to make room to put the instruments without damaging the hip joint.
- Specially made instruments are inserted into the hip joint again under x-ray control. Two or occasionally three small incisions 1 –2 centimeters long are made in the skin during the procedure.
- One incision is used to insert a camera, which displays the inside of the hip on a television monitor, and the other incision is to insert instruments for treatment of the pathology.
- Following the procedure local anaesthetic is injected into the hip and wound, and the wounds are sutured.
- You will usually be in hospital overnight for antibiotics and pain relief.
Post-Operation
Most hip arthroscopies are performed as an overnight procedure.
The following are guidelines to assist with your post-operative care until you see Dr Walker.
Bandage:
This will generally be removed the morning after surgery.
Dressings:
The dressings are covering up the wounds. Generally they are clear plastic, called opsites. These usually require
changing the day after surgery and are then left until Dr Walker sees you post-operatively.
Leave these on unless they are peeling off which they do sometimes. These seem to stick to some people’s skin better
than others. If they are peeling off and you need to replace them, do so as cleanly as possible i.e. use some sort of
antiseptic.
Under the dressing there are generally white strips called steri-strips. Try to keep these on. However, again, if they are peeling off you can replace them.
If the wound is actively bleeding, you should see your GP or go back to the hospital to change. This is rare.
Showering
You may get the dressing wet in the shower. Do not swim or bath until your review with Dr Walker.
Crutches
Crutches are generally used for comfort. You can fully weight-bear with the crutches unless Dr Walker specifies
otherwise. They are generally used for between 2 and 10 days.
Excercises:
A physiotherapist will generally show you some simple exercises to do. Formal physio can start after you see Dr
Walker post-operatively.
If your physio does not have any formal protocol, please see attached protocol from Sydney Sports Medicine Centre.
Try and avoid flexion of the hip beyond 90 degrees if you have had a labral repair.
Swelling and ice:
Swelling and some bruising is normal. ICING IS IMPORTANT. Ice for roughly 15 minutes every 2 hours until the
swelling reduces. Icing varies from a bag of peas to fancy expensive ice machines. Do not ice directly onto the skin as you can get an ice burn.
Pain:
Pain is to be expected. The anaesthetist will give you analgesics and/or anti-inflammatories. Take these as required.
Remember with opioid drugs, you cannot drive or operate machinery, so try and wean off these.
Concerns:
If your temperature rises over 38.5 degrees or if you are unwell (i.e. with rigors or shaking) contact Dr Walker or go to an emergency department.
If your wound becomes red please contact Dr Walker.
Follow Up:
Your check-up is usually 7-14 days after the surgery. Generally this appointment will be emailed to you. If for some
reason you don’t hear from us please contact Dr Walker’s rooms.
Further Reading
Hip Arthroscopy – Physio Protocol
Rehabilitation
Hip arthroscopies are usually not particularly painful. The operation is done either as a day procedure or an overnight stay. Patients are allowed to weight bear as tolerated immediately. During the early postoperative period, Dr Walker generally encourages patients to walk within limits of pain and to do gentle stretching exercises to keep the hip mobile.
Office workers can generally go to work after a few days, while physical labourers may take a month. Dr Walker recommends 2-3 months before competing fully in competitive sports; depending on the sport and level of competition. The patient can usually drive after a few days but needs to be off narcotics, not have a significant limp, and be able to control the brake and accelerator.
All patients are different and the following programme needs to be adjusted accordingly. If a particular activity is causing pain, avoid it for a few days and then slowly return to it.
Risks & Complications
Any operation, big or small, has risks. The following can occur with any surgery and some rarer complications may also be possible. It is impossible to discuss every complication and there will be some which no surgeon may anticipate or may never have heard of. The utmost care is taken at all times during surgery to prevent these complications. Potential complications include:
- Infection
- Nerve damage
- Vascular injury
- Ongoing pain
The above list is not exhaustive. For more information on complications:
Hip Arthroscopy Complications
Frequently Asked Questions
How long will I be in hospital?
You will usually be required to stay overnight.
When will I be able to drive again?
You should be able to drive after one or two weeks depending on your recovery.
When can I go back to work?
Time off work depends on your occupation (usually one to four weeks).