What is Hip Arthroscopy?
Hip arthroscopy is a minimally invasive technique that allows me to see directly into the hip joint using a fibre-optic camera and assess any damage or abnormality. Using two or three small incisions, usually 1cm in length I can treat many disorders that can cause pain or ‘pinching’.
Formerly large open procedures were required to access the hip joint which often necessitated long stays in hospital however most patients undergoing Hip Arthroscopy can go home the following day.
Conditions commonly treated with Hip Arthroscopy include:
- Labral Tears
- Femoro-Acetabular Impingement (FAI)
- Psoas Tendon Irritation (commonly after Total Hip Replacement)
- Cartilage Tears using microfracture and fibrin patches
- Ligamentum Teres injuries
- Snapping Hip
- Mild-to-moderate hip osteoarthritis with associated mechanical symptoms.
Hip Arthroscopy is safe and complications uncommon. The most common side effect include temporary discomfort, slight bruising, or numbness around the foot or groin related to the traction placed on the hip during the procedure. These occur in around 5% of cases and usually last only a few days. Serious complications such as infection, fracture, and permanent nerve injury are extremely rare. I will discuss the operation in detail with you prior to the procedure.
Hip arthroscopy is technically challenging. It should be performed by a surgeon who is appropriately trained in the technique. I have undergoing Advanced Fellowship training in Hip Arthroscopy in Oxford and Bristol, UK. More recently I have visited Mr. John O’Donnell in Melbourne and Mr. Richard Villar & Mr. Ali Bajwa at The Villar Bajwa Practice in Cambridge, UK to learn further techniques.
What are the Risks and Complications?
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the Knee. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.