Hip arthroscopy is a 'key hole' means of assessing and treating the hip joint, which enables a more rapid recovery and return to work. The technique can address intra-articular hip pathology such as labral tears, hip impingement, osteochondral defects, and loose bodies; and extra articular soft tissue pathology such as psoas tendonitis, bursitis and tendinopathy.
Total hip replacement is one of the most successful surgical procedures of the 20th century. Surgery predictably restores mobility and function. It enables young adults to continue to work, look after their children, and participate in low impact sports; and elderly patients whose mobility is deteriorating to maintain their independence.
A worn out implant can be as painful as arthritis or mechanically unreliable. Revision Total Hip Replacement involves removing the worn out implant and replacing it. It enables patients to regain their previous level of mobility, and elderly patients to maintain their independence.
Hip arthroscopy is a means of assessing and treating the hip joint using a minimally invasive technique, which enables a more rapid recovery and return to work. The technique can address intra-articular hip pathology such as labral tears, hip impingement, osteochondral defects, and loose bodies; and extra articular soft tissue pathology such as psoas tendonitis, bursitis and tendinopathy.
Patients with a labral tear generally present with groin pain provoked by twisting, or impact sports. This begins to have an impact on their ability to run, but can progress to affect walking and even sleeping.
A consultation would involve a series of questions to assess the degree of pain and the impact it is having on your level of activity. Please be prepared for a clinical examination of your hip to help find the cause of your pain. A plain Xray picks up most hip conditions and can be carried out and read at an initial consultation. Pre- arthritic conditions are best further assessed with an MRI scan.
If the cause of the hip pain can be addressed arthroscopically this involves admission as a daycase. You would require a general anaesthetic to allow the muscles around the hip to relax and allow the hip to sublux under traction. This enables the central compartment of the hip joint to be examined arthroscopically, and a labral tear be debrided or repaired. If the hip is impinging the causative bone can be burred back to reduce the risk of the process ongoing.
Patients usually wake up with swelling in their leg from the water used to inflate the joint during the arthroscopic examination. The physiotherapist will have explained preoperatively how to manage crutches and these are usually only necessary for two days. You will also be given some exercises by the physiotherapist and you should plan to start gentle early range of movement exercises immediately to prevent stiffness due to surgical scarring.
Most patients are advised to take two weeks off work. Some may work from home in the second week, but the advice is mainly to prevent early complications such as bleeding or pain provoked by attempting to return to work too early. If your work is relatively manual it would be worth discussing a staged return to work with your employer.
You should be able to manage low impact exercises such as a static bike and swimming from two weeks after surgery. By four to six weeks the hip should feel almost normal for day to day activities, and you should be able to return to the gym. You can progress on to cross training and then on to a treadmill as able; most have returned to running and team sports by three months.
You shouldn’t be driving while you are using crutches to walk, as there would be concern about your ability to manage an emergency stop. When you are able to walk independently and climb into and out of a car comfortably you should be safe to drive. But if you are planning to drive early after surgery please contact your insurer to ensure they are aware and prepared to cover you in the event of an accident.
There is a potentially increased risk of thromboembolism up to three months after surgery. The risk is dependent on length of flight, and preexisting risk factors. If you are considering a long-haul flight within six weeks of surgery it may be worth considering chemoprophylaxis to reduce the risk.
Potential complications of surgery
Surgery becomes ever safer and complications are rare, but there are still risks involved. There are general complications from any surgery such as infection, thromboembolism (blood clots), and blood vessel and nerve injury; and more specific ones to hip arthroscopy such as paraesthesia (numbness) which can affect the perineum, lateral thigh and foot.
Please contact my secretary or visit your GP if:
-You develop a temperature and the hip becomes increasingly painful, as there is a risk of infection.
-You develop increasing pain and swelling in your leg as there is a risk of thrombosis with lower limb surgery.
Impinging Hip Animation
Total hip replacement is one of the most successful surgical innovations of the 20th century. Surgery predictably restores mobility and function. It enables young adults to continue to work, look after their children, and participate in low impact sports; and elderly patients whose mobility is deteriorating to maintain their independence.
Surgery involves removing the worn out joint and replacing it with a new painless bearing. There are many different types of hip replacement. I recommend implants with a known track record and therefore the most predictable long term outcomes. I use a minimally invasive posterior surgical approach to the hip to minimise muscle injury and blood loss, which enables patients to walk the same day as their surgery.
Most patients have a shorter leg due to bone and cartilage loss as a result of their arthritis. One of the goals of surgery is to lengthen your leg to correct that leg length discrepancy. I use computer templating to more accurately achieve this and optimise your muscle function.
The majority of patients are admitted the morning of surgery. They have a spinal anaesthetic and some sedation. This makes for a swifter recovery from anaesthesia, so they can start to walk and rehabilitate the same day. Most patients are safe to go home the day after surgery, and walk without sticks or aids within six weeks.
ceramic hip replacement
At your outpatient appointment you will be asked to have an Xray of your hips with a calibration ball. This will demonstrate the degree of established arthritis, and calibrate the Xray so we can accurately plan your operation.
I will ask you some questions to establish how much your hip joint is affecting you lifestyle and whether this is the right time to intervene and replace your hip joint. I will also ask questions about your medical health to calculate the likely level of risk your are exposed to by both anaesthesia and surgery. I will then examine your hip to assess how painful it is, and its current range of movement.
You will be asked to have an Xray so we can see how worn your hip is and it can be used to plan your surgery. If we agree this is the right procedure for you, you can discuss timing and the centre where you would like to have your surgery with Gill. You will be asked to attend a preadmission clinic appointment prior to surgery to check your medical health approximately two weeks before your admission.
Most admissions are for two days. You will leave hospital with crutches, which you should use for the first 4 weeks, and then drop to one so you are walking independently by 6 weeks.
Some elderley patients with a significant preoperative disability, or who live alone, may wish to consider a rehabilitation unit after surgery. https://www.ggroup.co.uk/the-clavadel/
If you live alone this can pose a more challenging recovery from surgery. This is made much easier by organising yourself at home before you are admitted .
Washing - Put a chair in the bathroom so you can sit at a basin to wash. A long handled sponge will make washing your feet easier. Washing your hair will require assistance.
Meals - Move essential kitchen equipment to a height where you can easily reach them. Stock up the freezer with esay to prepare meals. Put a chair in the kitchen so you wont need to carry meals from the kitchen, which will be difficult with a walking aid.
Anti-thrombotic Stockings - You will need these for 6 weeks. They need to be changed changed every 2/3 days to check the skin integrity and prevent them doubling over and causing pressure areas. You will need assistance with this. This company can help:
Adaptive aids - You may wish to consider a raised toilet seat which makes it more comfortable to use the toilet initially after surgery, and a 'helping hand' to pick things up if dropped. Please ask at your preadmission appointment.
I recommend implants which have known track record and therefore a more predictable longevity. For younger patients I usually use uncemented implants which bond to the bone, and a hard on hard ceramic on ceramic bearing (Depuy Corail/Pinnacle). For more senior patients I usually use a cemented stem to support weaker more osteopaenic bone and an uncemented cup. Depending on level of mobility I would suggest either a ceramic or metal on polyethylene bearing (Stryker Exeter/Trident).
You should not drive until you feel you have the speed and mobility to perform an emergency stop - it is your own responsibility to restart driving when you feel it is safe to do so. Generally this will be six weeks after joint replacement and two weeks after arthroscopic surgery. An automatic vehicle could be driven two weeks after left sided joint replacement surgery, but you should inform your insurer if you plan to return to driving early.
Air travel within 12 weeks of surgery carries an increased risk of thromboembolism. This risk can be reduced by for example keeping well hydrated and walking during the flight, taking a shorter flight and longer after the surgery. If essential anticoagulants can be prescribed to reduce this risk, but another consideration should be the healthcare system at the destination if their was a problem.