Hip Arthroscopic Surgery
Hip Arthroscopic Surgery
Arthroscopy of the hip is unique from other joints such as the knee, in that access to the hip is somewhat more difficult. Therefore, in order to get into the joint we need to apply in-line traction to sub lux or pull the ball out the socket by about 1cm. This traction acts like a tourniquet in that it affects blood flow via the little vessels to the nerves, hence the surgical time in traction, at least, is limited to 2 hours. The consequence of this traction is that when you wake up you may feel like you have a numb leg or dead leg type feeling in both limbs. The opposite non-operative leg is also under traction to keep the pelvis level and stable so as not to influence the lumbar spine. Your private parts or inner thigh can also feel somewhat numb on occasion. Some patients can also develope pressure sores. I have had 3 reported cases over the last 10 years. We do take extra care to try and prevent these occurrences, however there is a reported 3 to 7% incidence of traction related complications, minor or severe. These however, all normally recover fully over time.
The incisions are on the outer side of the hip near the knobbly bit of the hip, known as the greater trochanter. Normally there are only two incisions. These are small 1cm cuts and my sutures are always underneath the skin and absorbable. Overlying these wounds you will have Steri-Strips and an Opsite waterproof dressing which is water-resistant enough to withstand showering. These dressings will remain on for a total of two weeks and I will remove them personally at the two-week follow-up in the rooms. My anaesthetist will also inject around the hip in terms of a local anaesthetic block. This block will result in the index side thigh being numb for longer, it is obviously for pain but it can also weaken the muscles so you must be careful when initially getting out of bed and should always have assistance. The physiotherapists are aware of this. Sometimes these blocks can last for 48 to 72 hours. Because of the traction we think, and its interference with blood flow, pain after hip arthroscopy procedure can be particularly intense for a short period of time. The pain is also aggravated by intravasation of fluid into the muscle fibers. It is alleviated by the application of a continuous passive motion machine (CPM). This is a machine where the leg lies in it and the machine flexes and extends the hip automatically. We can adjust the settings and paradoxically this early movement assists a great deal in alleviating discomfort around the hip. It is also an essential tool in the prevention of intra-articular adhesions. These adhesions can be a reason for later repeat surgery in order to release them if they are causing pain. This is also why I have stopped doing these procedures in day units, as this compromised my patient outcomes and initial pain control.
Additionally we apply an icepack for pain and swelling. By the following morning most patients are comfortable and ready to get out of bed with the physiotherapist.
We will always provide as much analgesia as possible short of stopping you breathing. Just because there are small incisions as per arthroscopic surgery it does not mean that you have not had an operation. Beneath the skin incisions usually there is a lot of surgical work performed. In the past this would have been done as a big open procedure. This must be kept in mind in order to have realistic expectations in respect of initial discomfort around surgery. The beauty of arthroscopic surgery is not only cosmetic but also the fact that it allows for discharge within 24 hours, as opposed to open surgeries which always have higher initial complication risks and require admission for 2 to 4 days or more. Most patients will not need crutches to walk with at the time of discharge. Driving and routine activities of daily living can be pursued the day after surgery.
Post-operative physiotherapy rehabilitation has been shown to have a measurable influence on outcomes, so compliance is important.