(key hole surgery)
This is minimally invasive operation that treats damage and pre-arthritic condition of the hip through minor incisions.
Conditions that can be treated with keyhole are:
Hip impingement (also known as FemoroAcetabular Impingement -FAI)
Removal of loose cartilage/bone within the joint
Ligament and tendon injuries
How we perform Hip Arthroscopy
Hip arthroscopy is performed as a day-case or overnight stay procedure. The operation is performed under a general anaesthetic and lasts about 1 hour.
We use a special table which allows us to gently pull on both feet and a soft support is placed between the legs. This allows us to open up the hip joint slightly.
Once this is done we can then access the joint using a small camera and a variety of specially designed instruments. We usually use 2 or 3 incisions which are around 1cm in length.
Labral tears can be trimmed or repaired.
The repair process involves passing sutures around the labrum and then securing them with tiny plastic anchors that are placed within the bone at the rim of the hip socket.
These sutures and anchors stay within the tissues and get covered with scar tissue over time.
Treatment of Hip Impingement
This procedure is also known as an
It is designed to remove the bony protrusion known as a Cam Deformity from the front of the ball joint of the hip.
A very small high-speed burr is used to reshape that front of the hip joint.
The hip is then bent up at the end of the procedure to check the impingement has gone.
Treatment of early arthritis
Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber. Damage to this tissue is common and occurs following twists or direct blows, such as falls or heavy tackles playing sports such as football and rugby. Arthritis can also commonly occur due to Hip Impingement.
Early osteoarthritis of the hip starts at the rim of the socket and then progresses to affect the whole joint.
The treatments for early osteoarthritis depends on the stage of the damage. We can use special tissue glues to stabilise early lesions. In addition we can use stem-cell rich bone marrow concentrate which is removed and processed from the patients own bone marrow during the surgery.
We can address larger areas of cartilage damage and loss with a technique known as microfracture.This encourages new cartilage growth in areas where it is absent.
Larger areas of osteoarthritis cannot be treated with these techniques. In these cases hip replacement is usually a better option
Hip Arthroscopy Q+A
What are the benefits of operation?
Most studies and our own data from Oxford suggests that 70-80% of patients who have a hip arthroscopy receive a significant benefit. This may take up to 9-12 months to fully settle down and at two years most patients are still either symptom free or have very minimal symptoms. A small proportion of patients, about 1 in 10, will return a year down the line and have no benefits and an even smaller proportion of patients, typically patients with serious damage in the hip joint such as significant arthritis, will have worse pain after the operation.
When can I drive after surgery?
Most patients will be safe to drive a three weeks following surgery. We recommend that you contact your insurance company following the operation to tell them that you have had the surgery as many insurance contracts contain a clause that makes them void if you do not tell them of a change in your medical condition.
Will I need to be on crutches after surgery?
Most people are on crutches for two weeks and are able to walk independently thereafter.
Do I need physiotherapy?
You will need physiotherapy within the first 2 weeks. Generally speaking we encourage people to use a local gym focusing on cycling and range of movement exercises within the first 6 weeks. Longer-term physiotherapy is tailored to the needs of the patient.
How long will I need off work?
Most patients require three weeks off work for a desk based job, with a phased return to work from weeks 4 to 6. For manual jobs we would recommend at least six weeks off work. For athletes we would tailor make a recovery programme to suit their particular sport.
When can I return to sport?
You can return to cycling and swimming within three weeks of the operation, or as pain allows. However, contact sports and sports where deep squatting is likely are inadvisable before the six week stage. Thereafter a physiotherapy guided return to sport is possible in almost all patients.
What complications can there be?
Complications are extremely rare following hip arthroscopy but the most common complaint is of slow recovery which can take 6-9 months and is dependent on the amount of physiotherapy received. We will arrange significant amounts of high quality specialized physiotherapy after surgery in order to minimise the recovery time. Serious and very infrequently occurring complications such as infection, damage to structures such as nerves and blood vessels, deep vein thrombosis and pulmonary embolus are exceedingly rare have a less or equal than 1 in 100 chance of developing after surgery. Occasionally as we use traction during the procedure occasionally patients complain of a sore groin/genital area. This is rare and probably occurs less than 2% of the time. Very rarely instruments can break in the joint, bones can break or the surgeon can find it impossible to access the joint.
Will I ever need another hip arthroscopy?
Re-operation following initial hip arthroscopy is uncommon. Occasionally patients re-tear the labrum especially if they have trauma. Occasionally patients develop new pathology in the hip and require a repeat hip arthroscopy. The risk of this is probably less than 1 in 10 over a five year period.