HIP SCOPE SURGERY
Once it has been determined that you are a candidate for hip arthroscopic surgery, you will be taken through the process of admission and on occasion there may be the need for pre-operative special investigations depending on your background physical status.
Following admission to the hospital, you will be made comfortable in the ward and then transferred to the receiving room in the theatre suite. In the interim you will have met your anaesthetist who will go through the anaesthetic procedure required for hip arthroscopy. This may take the form of spinal or epidural anaesthesia together with light sedation or a full general anaesthetic. Part of the procedure is the application of traction to distract the hip, therefore muscle relaxation is a prerequisite.
As the surgeon I will also see you in the ward to finalize your consent, mark the limb we will be operating on and discuss any last minute questions you may have. You will then be transferred to the actual theatre and placed on the operating table which is designed to provide traction on the leg to be operated on. You will be given intravenous antibiotics to guard against infection. In order to scope the hip joint the anaesthetist will administer a muscle relaxant and traction will be applied to the affected leg with counter traction via the normal leg and a post in the groin. Great care is taken to pad and protect all areas of the limbs and groin that will be subject to pressure. Despite this though there is often and “dead leg “sensation after surgery that usually resolves by the time one is discharged. In men there may be numbness of the private parts, but this all resolves in time.
The leg that is to be scoped will be draped so as to isolate the hip joint and leg and thereafter treated with an antiseptic solution. The rest of the body is covered. Using x-ray guidance, the appropriate small surgical incisions for passage of the arthroscope and fine instrumentation, will be made. The inside of your hip joint will be examined thoroughly and appropriate pictures taken. Thereafter the diagnosed problem will be dealt with as appropriate. Following removal of all instrumentation, the wounds will be closed with small sutures under the skin that dissolve away over 3 to 6 month period, and appropriate dressings that are water resistant enough to shower with, are applied. Depending on the nature of the intervention, this procedure can take anything from thirty minutes to two hours.
After surgery you will be transferred to the recovery room where your vital signs will be monitored while you are recovering from the anaesthesia. Once the anaesthesia has worn off and you are able to eat and drink comfortably, arrangements will be made for discharge back home. Usually this may either be the same day or the following morning. Often a dressing change is required before discharge, as the muscles tend to absorb a lot of the sterile fluid pumped through the hip joint during arthroscopy. You will also be seen by the hospital physiotherapist who will get you up on crutches and teach you a set of exercises to perform three times a day for the first 2 weeks. I will then see you in the rooms to remove the dressings and give you an out-patient physio referral. At this point the surgery will be discussed in detail and your intraoperative pictures shown to you.
The beauty of arthroscopic surgery is that post-operative recovery is usually quite quick and the fact that the incisions are no more than 1cm in length results in a quick healing process. Nonetheless there is usually a lot of work that has taken place beneath the visible scars and your hip will experience some discomfort for up to 3 months and a final outcome scoring is only done at 6 months. You will however be encouraged to drive and walk around from the 1st day after surgery and after six weeks you must stretch into pain to regain full range of movement at the hip. Not moving because of pain actually does more harm. After 3 months a functional sport orientated rehab program is begun, and it is only at this time that I allow my patients to begin running again. In the first 3 months the emphasis is on balance and joint position sense (Proprioceptive) work together with a strict stretching program with the physiotherapist.
Often, a pair of crutches is required for mobilization while only placing half your body weight on the affected side with the foot flat on the ground. This is mainly for pain control and is for the first 2 weeks only. In some cases crutches are required for longer, up to 6 weeks, such as in hip dysplasia and if there has been a lot of bony resection.
There may be certain restrictions in terms of range of allowable movement at the hip so as to allow any repairs to consolidate before moving on to regaining full range of movement and muscle strength around the hip joint. This restriction is never more than 6 weeks. In all cases early movement is encouraged. The wounds are considered waterproof so as to allow normal bathing at approximately ten days following surgery. In most cases the sutures are absorbable and placed underneath the skin. Top end sports men and women usually return to sport by 6 months.
Hip arthroscopy (keyhole surgery) is a very valuable tool allowing orthopaedic surgeons to deal with many problems afflicting the hip joint without the need for large incision invasive surgery. It also affords us the opportunity to hopefully prevent early onset wear and tear arthritis by means of minimally invasive procedures that allow repair of damaged structures and a quick post-operative recovery. It remains the gold standard in terms of diagnosis of difficult hip problems. It remains a technically demanding procedure and many of the indications for hip arthroscopic surgery are still under review, however for the most part one can expect and excellent result following surgery.