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 out the ball from 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. For men, their private parts can also feel somewhat numb on occasion. I have had one case where they were unable to achieve an erection for up to 2 weeks. Interestingly His wife was more concerned than he was. This however did recover and is the only case especially now that we have more appropriate foam bolsters as part of the modern traction tables.
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. 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 assists 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.
Also with hip arthroscopy there are large muscles around the joint and there will be fluid extravasation into the muscles. This can result not only in swelling but the high level of fluid within the muscles can be a source of muscular pain. This will dissipate with the use of an ice pack and CPM and again 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 to 48 hours, as opposed to open surgeries which always have higher complication risks and require admission for 2 to 4 days or more.
Post-operative physiotherapy rehabilitation has been shown to have a measurable influence on outcomes, so compliance is important.