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Different types of hip impingement
Pincer type Hip Impingement animation
CAM type Hip Impingement animation
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.