Certain hip conditions may require surgery – especially if conservative treatments haven’t been successful. For example, a labral tear often requires torn tissue to be surgically reattached to the bone or cleaned up to stop popping, clicking, or catching.
Surgical advances now allow us to treat previously untreatable conditions, and make treating other conditions easier and safer.
Hip surgeries other than a total joint replacement – including impingement, bony defects, and labral tears – can be done arthroscopically. Often, arthroscopic hip surgery can address multiple hip conditions simultaneously.
Before your surgery is even scheduled you’ll meet with your orthopedic surgeon to talk over the surgical procedure, its risks and benefits, and any questions or concerns you may have.
Hip arthroscopy is an outpatient procedure, performed either at the Ambulatory Surgery Center, in which case you go home later in the day, or in the hospital. If you have surgery at the hospital, you’re typically discharged home the next morning.
Either way, you’ll arrive at the facility about an hour and a half before your surgery time. Our staff will check you in, have you change into a surgical gown, listen to your heart and lungs and check your blood pressure, pulse, and temperature. We then start an IV to give you fluids and medications, and prep the surgery site.
The anesthesia staff will meet with you to review your health history, past surgeries, and current medications, and discuss your anesthesia options.
A general anesthetic with a nerve block is a common form of anesthesia for hip surgery. The anesthetic puts you to sleep for the duration of your surgery. The nerve block numbs the hip area and can last for several hours after surgery, which helps manage your pain.
A surgeon and a physician’s assistant (PA) will lead your surgical team in the operating room.
Once you’re fast asleep in the operating room, your hip is filled with saline, to expand your joint and make it easier for your surgeon to move surgical instruments and see tissues. To see inside your joint, your surgeon uses a special table that separates your thighbone from its socket on the pelvis. Your foot is strapped into a boot that pulls your leg away from your pelvis, creating more space in the hip joint for surgical instruments.
At that point, your surgeon inserts an arthroscope – a tiny camera connected to a large monitor that lets your surgeon clearly see the structures in your hip.
Once your surgeon can see in the joint, they insert surgical instruments through another incision and repair damaged tissue. Often, multiple tiny incisions are made to get to different areas in your hip. While in your hip, your surgeon will usually fix any repairable damage they find, even if it was unexpected.
Even MRIs can miss damage, but during an arthroscopy, your surgeon can see exactly what is problematic.
After surgery, your surgeon will explain to your family what they found in the operating room and any limitations you’ll have using your leg.
You’ll be placed on crutches for the first day and will stay on crutches until you regain full sensation in your hip, can bear full weight on your leg, and can walk comfortably. If a repair is needed or more intensive work was done, you may need to use crutches without putting any weight on the leg for a few weeks.
Usually, your surgeon will have you just rest and recover for a few days after surgery. After that, you may take off the bulky surgical dressing and can shower.
Caring for yourself after a hip arthroscopy can be easier if you have extra help. Don’t be afraid to ask for help if you need it. If you’re having a hip replacement, talking with our joint coordinator can help alleviate some of your post-surgery concerns.
After approximately two weeks, you’ll visit with your surgeon or a PA and talk about your surgery and your recovery process.
Sometimes you can begin moving your hip and returning to activities on your own, as you feel able; other times you may require physical therapy.
It takes most patients one to two months before they’re back to daily activities. Labral repairs can take patients up to three or four months before they’re back to regular activities; however, it can take up to a year before they no longer notice hip pain.
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Hard Cartilage Damage and Chondroplasty
The bony surfaces of the hip joint are covered by hard cartilage, which should ideally be smooth. Defects or flaps in the hard cartilage can cause a painful catch or click, limit the motion of your hip, and potentially damage healthy tissue in your hip.
Relatively small defects can sometimes be polished and smoothed with gentle motion exercises like riding an exercise bike. Severe hard cartilage damage may require surgical intervention to remove unstable tissue flaps.
A hip chondroplasty uses a surgical instrument to remove fraying or flapped hard cartilage and smooth down remaining tissue. After this procedure, you are often placed on crutches for a few days and can wean from them gradually. Your surgeon will outline your post-surgery restrictions.
Labral Tears and Debridement vs. Repair
Inside the hip socket is a flexible rim of soft tissue called the labrum, which helps increase the stability of the hip. The labrum can fray or completely tear, causing a flap of tissue to catch within the hip joint. This can cause pain, popping, and a feeling of instability in your hip.
This condition can be treated arthroscopically. Minor labrum damage you may only need a debridement, where a surgical instrument removes the fraying or flapped labrum and smooths down remaining tissue. After a labral debridement, you are often placed on crutches and may begin to wean from them as you tolerate.
For a completely torn labrum that requires repair, your surgeon will often use anchors made of a bone-like substance to sew your labrum down to the bone. Over time, your body turns the anchor into your own bone. The number of sutures used during surgery will depend on the size and severity of your injury.
After a labral repair, you will be given specific post-op instructions, but you can expect to use crutches for up to six weeks. Your surgeon will tell your family exactly what your restrictions are after surgery.
Femoroacetabular Impingement (FAI) and Arthroscopic Femoroplasty
Femoral acetabular impingement (FAI) occurs when bone spurs form in the hip, causing abnormal motion within the hip joint and rubbing on the hip socket, which damages the hard cartilage on the bone or the soft-tissue labrum. This typically occurs in young and middle-aged adults.
There are two different types of FAI, depending on whether the bone spurs form on the thigh bone or on the hip socket. Both can cause pain, limited motion, and more damage to other structures in the hip.
During an arthroscopic hip surgery, your surgeon will go in the hip joint and remove any bone spurs or excess bone. Your surgeon may use fluoroscopy, a special type of X-ray, to determine when they have restored an appropriate shape to the hip socket and/or thigh bone. Any damage to the surrounding soft tissues in your hip joint will also be debrided or cleaned up. Sometimes labrum repair is necessary.
After a femoroplasty, you will go home using crutches for the first few days and then can walk as tolerated. Your surgeon will outline your post-surgery restrictions.
The initial recovery for a femoroplasty is relatively short; however, the surface where the spur was removed can be sore for a few months following surgery, as it takes time for your body to develop a new hard covering on the bone. This procedure is typically very helpful and bone spurs rarely return.