Hip Arthroscopy

Typically recommended for physically active people experiencing hip pain due to labral tears unresponsive to conservative measures like physical therapy, medication, or rest. The surgery can also be an option for those who have continued hip issues even after non-invasive treatments or those with substantial joint damage. The optimal timing for the procedure varies depending on the severity of symptoms, the degree of impingement, and any pre-existing conditions in the hip.

Usually done under general anesthesia, your hip surgeon Dr. Mayo makes multiple minor incisions around the hip area. An arthroscope, a miniature camera, is inserted to provide a clear visualization of the hip joint. This camera aids in evaluating the state of the labrum and the degree of FAI present. For better access and movement of surgical tools, a small incision is made in the hip capsule, which is later stitched back together.

Hip Arthroscopy for Labral Repair

Repairing the labrum is often the initial surgical option for treating a hip labral tear. Special suture anchors are employed to sew the torn labrum back into place, facilitating its natural healing. This method is mainly suitable for patients whose labrum is healthy but torn, without significant degeneration.

Hip Arthroscopy for Labral Debridement

In situations where the labrum is frayed or worn out, a technique called debridement may be chosen to remove the damaged tissue. This option is often best for older individuals or those with significant degenerative changes where the tissue is not amenable to successful repair. Although debridement often allows for a faster recovery period compared to repair, it may not offer the same level of long-term joint stability.

Hip Arthroscopy with Labral Reconstruction

Should the labrum be irreparably damaged, reconstruction may be necessary. In such cases, a graft, either from the patient (autograft) or a donor (allograft), is used to replace the damaged labrum. The goal is to reinstate the natural anatomy and function of the hip joint. This surgical option is mainly considered for younger, more active individuals who have had an unsuccessful prior hip surgery or where the labrum cannot be repaired.

Hip Arthroscopy with Femoroacetabular Impingement (FAI) Surgery

Often, a hip labral tear coexists with FAI. During hip arthroscopy, the bone abnormalities contributing to FAI are also corrected to prevent further harm and promote healing. This may involve shaving off extra bone growth on the femoral head/neck (cam lesion) or acetabulum (pincer lesion).

While recovery time frames vary, patients can usually start to walk using crutches shortly after surgery and gradually transition to regular activities within a few weeks. An in-depth physical therapy regimen typically commences right after the procedure to assist in regaining hip strength and mobility. Light activities or desk jobs can generally be resumed within several weeks, with a full recovery for high-impact sports or jobs expected later.

Expect some swelling and discomfort in your hip area post-surgery. You’ll likely need crutches to assist with walking for a few weeks. There will also be certain movements to avoid, like flexing your hip beyond 90 degrees. Pain medication will be prescribed by your hip surgeon Dr. Mayo to help manage the post-operative discomfort.

Post-surgical physical therapy is crucial for successful recovery and can be broken down into:

• Early Stage (Weeks 1-6): Initial focus is on mitigating pain, reducing swelling, and regaining movement.
• Middle Stage (Weeks 6-12): Incorporates strength-building, stability, and endurance exercises, as well as gait training.
• Late Stage (3 months onwards): Specializes in functional and activity-specific training to prepare you for the resumption of work, sports, or day-to-day activities.

While generally safe, potential complications can include:

• Infection: A very minimal risk, mitigated by prophylactic antibiotics.
• Nerve damage: Small risk but minimized by employing modern surgical techniques.
• Blood clots: DVT or PE are rare occurrences, mitigated by a preventive aspirin regimen.
• Labral repair failure or FAI recurrence: Rare but may require further treatment.
• Excess bone formation: In rare instances, extra bone may form around the hip, causing potential issues. Preventive medication is administered post-surgery.

Choosing not to undergo recommended surgery may result in:

• Ongoing pain and mobility challenges: The issues causing the hip discomfort are likely to continue.
• Further joint degradation: Prolonged FAI and labral tears may lead to more severe damage, potentially causing premature arthritis.