Hip arthroscopy

Hip arthroscopy is a type of keyhole surgery — a minimally invasive technique to diagnose and treat problems inside the hip joint. 

A tiny camera (arthroscope) is inserted through a 0.5–1cm cut in the skin, sending images to a monitor so your surgeon can identify the cause of your hip pain. Using miniature surgical instruments, they can repair issues such as cartilage damage, extra bone growth and inflammation.  

Why might I need a hip arthroscopy? 

Your hip is a ball and socket joint, formed by the ball at the top of your thigh bone (femur) sitting in the cup shaped socket (acetabulum) of your pelvis. Both are covered with a smooth, slippery layer of cartilage that cushions the joint as you walk. The hip socket is surrounded by a ring of cartilage (labrum), which holds the ball of the thigh bone in place and seals the joint to keep fluid inside. 

Wear and tear, abnormal bone shape or injury can cause damage to the cartilage, labrum or bone, leading to chronic pain, swelling, instability (clicking or giving way of the hip joint when you walk or run) and reduced mobility in your hip. If nonsurgical treatments haven’t helped, you may be referred for a hip arthroscopy. 

The aim of a hip arthroscopy operation is to look inside the joint, confirm the diagnosis, and treat the condition. 

Typically, hip arthroscopy is performed to treat one or more of the following issues: 

• Labrum and tendon tears
• Synovitis — inflammation in the lining of the hip
• Femoroacetabular impingement — pinching between the bones of the hip joint due to irregular bone shape
• Loose fragments — such as bone or cartilage that may be catching on the joint
• Hip dysplasia — where the femur does not fit properly in the pelvis
• Bone spurs — stopping the joint from gliding smoothly

If left untreated, problems such as cartilage damage or impingement can lead to arthritis. 

Is hip arthroscopy right for you? 

Hip arthroscopy may not be suitable if you have advanced arthritis, certain types of hip dysplasia, or significant joint damage. If you are pregnant you should wait until after the birth to have your hip arthroscopy. 

If you have a body mass index (BMI) of over 30, the procedure may not be possible due to the increased difficulty of accessing the hip joint and the higher risk of complications. You can calculate your BMI by taking your weight in kilograms and dividing it by your height in metres. 

Are there alternative treatments to hip arthroscopy? 

Many people find relief from pain and increased mobility with non-surgical treatments such as: 

• Activity modification
• Anti-inflammatory medication or steroid injections
• Lifestyle changes such as weight management
• Physiotherapy
• Switching to low-impact exercise 

However, if pain persists then a hip arthroscopy may be a good option.

The operation is carried out via keyhole surgery. Once you’re asleep, your leg is placed into straps and pulled straight. This allows the ball of the hip (femoral head) to be separated slightly from the socket, creating space for your surgeon to safely insert a camera and surgical instruments.

A small 1–2 cm cut is made near your hip and a tiny camera (arthroscope) passed through. This projects live images onto a screen so your surgeon can look inside the joint and assess the damage. If needed, 1 or 2 additional small cuts are made and tiny surgical instruments used to: 

• Remove loose fragments
• Repair a torn labrum
• Smooth damaged cartilage
• Trim bone spurs 

In some cases the surgeon may also tighten the joint lining if it’s too loose, or slightly release it if it’s too tight. 

Throughout the operation, sterile water is gently pumped into the joint. This helps expand the space inside the hip, making it easier for the surgeon to see and move the instruments around. While the water is drained after surgery, your hip and thigh may feel a little swollen for a few days. 

After surgery, the incisions (cuts) are closed with stitches and a sterile dressing is applied.

Before your procedure 

You’ll be sent a pre-admission form to fill out before your surgery. This collects information about your overall health, medical history, and any medication you’re taking, as well as information about your living situation and the level of support you need.  

Hip arthroscopy is usually performed as a day case, but sometimes you may need to stay in hospital overnight. Your care team will discuss this with you.  

Preparing for your surgery 

If you smoke, you will be advised to stop several weeks before surgery. Smoking slows down healing and increases your risk of infection. In the weeks before surgery you should stay active and follow a healthy diet, high in fruit and vegetables, whole grains and lean protein. 

Most people will need help for the first few days after surgery. If you live alone, consider asking a friend or relative to stay with you while you recover. 

Preparing your home for after your surgery will help: 

• Clear walkways and remove trip hazards
• Keep items you use regularly in easy reach
• Have a firm chair with arms and extra pillows ready
• Stock cupboards and your freezer with pre-prepared meals 

Your care team can advise you on any special equipment that will help during your recovery. 

You will need to arrange for someone to collect you from the hospital and take you home after your surgery. 

Who will be involved? 

Your care team will include an orthopaedic surgeon — a surgeon who specialises in the surgical treatment of conditions affecting the bones and muscles. 

Your care team will also include an anaesthetist, nurses and a physiotherapist. 

On the day of the procedure 

You can shower or bathe before you arrive, but avoid using lotions around the hip area. 

Hip arthroscopy is normally carried out under general anaesthetic (where you’re asleep), so you will need to stop eating and drinking (fast) several hours before your surgery. You will be advised on how long you need to fast for in your admissions letter. 

When you arrive at the hospital you will be given a pre-operative assessment by your care team and have the opportunity to ask any questions about the procedure. 

You will be given a gown and disposable underwear to change into before you’re taken to the operating theatre. 

The procedure 

Hip arthroscopy usually takes between 1–2 hours, however this can vary depending on the complexity of the procedure. 

Anaesthetic choices 

Hip arthroscopy is normally carried out under general anaesthetic, along with a local anaesthetic that numbs the hip area for several hours. 

If you have ongoing medical issues, you may be offered a regional anaesthetic where you remain awake. This blocks pain signals from the nerves and numbs your hip.  

What happens after surgery? 

You will be transferred to a recovery room where you will be monitored as the anaesthetic wears off. The anaesthetic may make you feel sick, but this usually improves within 24 hours. 

You are likely to feel some hip discomfort on moving, and will be given painkillers. There may also be discomfort in the lower back, buttock, knee and ankle. Most people will have swelling in the groin, buttock and thigh, which will reduce in the coming days. 

Immediately after surgery you will be encouraged to get up and walk a short distance with crutches. An hour or 2 after surgery you can drink and eat (providing you’re not feeling sick) and should be back to your normal diet the next day. 

It’s common for your bowels not to open for a day or so. If they still haven’t opened after 2 days you can take a laxative. 

You will need to have had food and drink, passed urine, and be able to walk around before you can go home. You will normally be given a special stocking to wear and up to 4 weeks of blood thinning medication to reduce the risk of developing blood clots. 

General anaesthetic can cause you to feel drowsy so it is important not to drive, use heavy machinery, cook, consume alcohol or make any important decisions until at least 24 hours after surgery. 

What happens after surgery? 

Recovery from hip arthroscopy varies depending on the procedure you had. Most people with desk jobs are back to work in 2–4 weeks, while returning to sports or heavy labour may take 3–6 months. Full recovery from hip arthroscopy normally takes between 6–9 months.

You will need to use crutches for 2–4 weeks following your operation to limit weight-bearing while the hip heals. 

You will be given physiotherapy exercises to do for at least 6 weeks to improve your range of movement and hip stability. These are vital for the best outcome and it’s important to do them daily to build up strength and endurance. Some people may also have hydrotherapy ie exercise in a swimming pool. 

Wound care 

You will have a dressing on your wound after surgery and should keep this on until your outpatient review. There may be some bruising and swelling around the wound and tiny blisters along the wound line at first.

The wound should be kept dry until the stitches or dressings are removed. Shower with the wound covered and avoid soaking in a bath. The stitches are normally removed 7–10 days after surgery. 

Pain management 

During the operation you will be given long-acting local anaesthetic. This normally wears off after 6–8 hours, when you will be given painkillers to take for the next 48 hours. A good rule of thumb for taking painkillers is to take enough to allow you to move around comfortably, but not so many that you feel drowsy. 

Smoking 

Smoking is known to increase the risk of wound infection and poor healing. Using this opportunity to stop smoking will reduce your risk of chronic (long-term) cough and straining your wounds. If you would like help with quitting smoking your doctor will be able to advise you. 

Diet 

Drink plenty of water and follow a high fibre diet to avoid constipation as this can increase strain on the wound. It’s a good idea to avoid alcohol while taking painkillers. 

Are there any activities I should avoid? 

For the first 8 weeks after surgery you should avoid standing on hard surfaces for long periods of time, long walks, heavy lifting, squatting, and sleeping on your side. Don’t take part in high impact sports such as running, football or tennis for at least 3 months. 

Driving 

Check whether your car insurance provider has specific rules on when you can resume driving. You should not drive until you can walk comfortably without crutches, are off pain medication, can safely control the vehicle, and make an emergency stop without significant pain to your hip. This is normally 2–6 weeks after your surgery. 

Time off work 

When you return to work will depend on the complexity of your procedure and your job. Those with desk jobs can normally return within 2–4 weeks. Work involving standing or light activity may need 4–6 weeks, and those in physically demanding roles usually need 3–6 months off work.  

When will I be back to normal? 

Most people are walking relatively pain-free within 2–3 months of surgery. Full recovery takes 6–9 months.

Every surgery comes with risks; however, complications following hip arthroscopy are rare. Tell your anaesthetist if you have ever had an adverse reaction to an anaesthetic ie a bad response, such as an allergic reaction, breathing difficulties or muscle spasms. 

Hip arthroscopy requires traction (gentle pulling on the leg) to open the joint, and this can sometimes cause numbness or altered feeling in the groin or genitalia region. This will normally improve in a few weeks. 

Seek medical advice if you develop any of the following: 

• Increased pain, swelling, redness, bleeding or discharge at the site of the wound
• High fever or chills
• Unexplained cough, shortness of breath or chest pain
• Unexplained swelling of the calf 

Pregnancy 

If you are pregnant, you should avoid having a hip arthroscopy until after giving birth. General anaesthetic, traction on the hip, and X-rays all carry potential risks for a baby.