Your hip is a ‘ball-and-socket’ joint; the ‘socket’ of the hip is called the acetabulum and is part of your pelvic bone, and the ‘ball’ is the round head of the upper leg bone (the femur). The joint is reinforced by ligaments, cartilage, the labrum and other components which all work together to allow your hip to carry out its motions smoothly, with stability, and pain-free. If any of these components become damaged, symptoms may occur, such as pain, swelling, clicking, stiffness, and the loss of full range of motion. The cause of these symptoms may be a defect which is repairable through arthroscopic surgery.
Arthroscopic surgery is a technique which allows the surgeon to operate through two or three small (1 cm) incisions located in the region of the upper leg and hip. A video-camera is placed in one incision to visualize the inside of the hip joint, and specialized surgical instruments are inserted into the other incisions. The leg is placed in traction in order to separate the hip joint enough for the surgeon to be able to see the joint clearly and operate without damaging any structures in the joint. The benefits of an arthroscopic technique include small scars, a minimized risk of blood loss and infection, and a quicker recovery.
Hip arthroscopy encompasses a wide range of procedures, for the treatment of a number of different injuries and conditions. It can be used to trim or remove damaged tissue, to reattach or repair damaged or torn tissue, or to correct bone abnormalities. Common problems treated using hip arthroscopy include the following: a torn labrum, loose bodies within the joint, damaged cartilage, and femoroacetabular impingement (FAI). The goals of a hip arthroscopy are to alleviate symptoms, improve the function of the joint, and prevent future degenerative changes in the joint.
Hip arthroscopies are performed as day procedures, which means that the patient will come in to the hospital in the morning and will go home in the afternoon. They are performed under general anesthetic, and a nerve block may also be used to numb the area and reduce post-operative pain. Stitches and steri-strips will be used to close the incisions and they will be covered with dressings. See the “Day of Surgery” section for more details regarding the day of surgery.
As with any surgery, a hip arthroscopy does carry some risks. These risks include, but are not limited to, pain, stiffness, scarring, infection and nerve damage. In the majority of cases, these complications are not permanent and should resolve over time, or are reversible with appropriate treatment. Your surgeon will make every effort to minimize these risks.
Recovery and outcome following hip arthroscopy will differ from patient to patient and will depend largely on the specific procedure performed, and the individual’s pre- and post-surgery levels of physical activity. Recovery after surgery takes months of hard work to rehabilitate the hip in order to achieve a full range of motion and adequate strength for physical activity.
Following surgery, you will be using crutches and will be limiting your weight bearing to toe-touching in the beginning. Your surgeon will outline your specific weight bearing limitations, which will depend on the procedure preformed. It is common to experience some pain and discomfort in the days after surgery, but this will decrease over time. You will come in to the clinic for your first follow-up appointment at about 2 weeks post-op, and which time your incisions will be checked. You should begin physiotherapy in the first 2 weeks following surgery to work on reducing swelling, and increasing strength and range of motion.
Following surgery, the goal is to end up with a hip that feels strong, with reduced pain, an improved range of motion, and one which allows you to be physically active. Although this goal is achieved in most patients, some individuals will find that even though their hip is improved, some symptoms may persist.
FAI is a condition which occurs when the upper leg bone (femur) is prevented from completing a full range of motion at the hip because it hits against the upper edge of the hip socket (the acetabulum) in the front of the joint. It occurs as a result of excess or irregular bone growth either around the head and neck of the femur (a “cam” impingement), the rim of the acetabulum (a “pincer” impingement), or both. This can cause bone and cartilage damage and can pinch other joint tissues in between the two bones. Over time, this can lead to damage of many structures in the joint, such as the wearing away of cartilage, tears of the labrum, and the development of osteoarthritis.
The precise cause of FAI is not well understood, but there are many potential causes that are associated with the development of FAI. FAI tends to get progressively worse over time as more damage occurs to surrounding structures and to the bones themselves.
The most common symptoms of FAI are pain in the hip joint and groin, and the loss of full range of motion (generally the loss of full flexion and internal rotation of the hip). It often develops slowly over time, but can also begin suddenly. For many individuals, the pain tends to be worse after prolonged periods of sitting, walking, or physical activity. It may be noticed particularly in positions of extreme flexion, consequently limiting one’s range of motion. Some people will also experience feelings of catching or popping in the joint.
In order to diagnose FAI, the doctor will take a history of your physical activity background, any specific injuries sustained, and all hip symptoms and pain. The doctor will also physically examine your hip to determine what movements cause pain, and to evaluate any loss of range of motion. This will allow the doctor to determine whether your symptoms fit the picture of FAI.
Imaging such as x-rays and MRIs are also used in the diagnosis of FAI. X-rays demonstrate the shape of the bones and any irregular bone growth, while MRIs show soft tissue, allowing damage to the cartilage or labrum to be visualized. In some cases, CT scans can also provide additional useful information.
Often, before a surgical route is undertaken, a more conservative management path will be attempted. This could involve any of the following: rest, activity modification, techniques to reduce swelling, and physiotherapy and exercises to increase hip strength. In some patients this can provide adequate symptom relief, and surgery is not needed, however, it often requires the individual to reduce their level of physical activity and/or alter their lifestyle.
If symptoms persist, a hip arthroscopy may be considered. The goals of surgery are to eliminate symptoms, to prevent further degenerative changes in the joint, such as arthritis, and to allow the individual to return to their desired level of physical activity. In this procedure, irregular bone growth is shaved down or trimmed, and damage to other joint structures is addressed. This could include repair to the labrum, removal of damaged or torn pieces of labrum and cartilage, and stimulating new cartilage growth.
Recovery and outcome following surgery for FAI will differ from patient to patient, and depend largely on the specific type of abnormality, the type and amount of associated damage to the hip joint, and the individual’s pre- and post-surgery levels of physical activity. Recovery after surgery takes months of hard work to rehabilitate the hip in order to achieve a full range of motion and adequate strength for physical activity.
Following surgery, you will be using crutches and will be limiting your weight bearing to toe-touching in the beginning. Your surgeon will outline your specific weight bearing limitations, which will depend on the procedure preformed (e.g. whether or not a labral repair was preformed, and how much work was done on the bones). It is common to experience some pain and discomfort in the days after surgery, but this will decrease over time. You will start physiotherapy soon after surgery and will come in to the clinic for your first follow-up appointment at about 2 weeks post-op. See the “FAQ” section for more details regarding the first two weeks after surgery. Recovery should be a steady improvement in the long-run, however, there will be bumps along the way. It takes at least 3-4 months of rehab before returning to physical activity.