What is hip arthroscopy?
Hip arthroscopy is a minimally invasive surgical procedure used to treat a variety of hip disorders. Dr. Garabekyan makes two small incisions (each ~ 1/2” in length) on the outer aspect of the hip and utilizes fiber optic cameras and specialized instruments to repair damaged cartilage and restore normal bony anatomy. Unlike hip arthroplasty, or joint replacement, which involves the use of artificial bearings to replace the joint, the goals of hip arthroscopy are to promote healing and preservation of native biologic tissue and prevent, or significantly delay, the future need for joint replacement surgery.
Hip Arthroscopy Without a Post
Hip arthroscopy is typically carried out by using an operating table with the patient’s legs strapped in specialized boots to apply traction and create working space in an otherwise tight hip joint. In order to prevent the patient from being pulled down the table, a counterforce is used in the form of a large padded post placed in the perineum (between the legs – Figure 1). Despite efforts to reduce the traction force and duration, horrible complications have been reported in the literature including genital numbness and tissue necrosis. Some patients are left with permanent sexual dysfunction requiring additional urologic treatment, a devastating complication for a young male or female undergoing an elective, outpatient procedure. Dr. Garabekyan utilizes a safer technique for counter-traction without a post, removing all pressure form the perineum (Figure 2). Traction forces are lower than the conventional technique and patients can rest assured that they will not be dealing with a life altering complication.
What is the typical timeframe for recovery from hip arthroscopy?
It is important to realize that the speed of recovery depends largely on the extent and type of damage in the hip along with other patient related factors. Generally speaking, though, the majority of patients can expect to:
- Go home on the day of surgery
- Resume normal daily household activities within 1 – 2 days
- Take prescription pain medication for 3 – 5 days
- Return to a desk-job with intermittent walking at 7 – 10 days
- Drive a car at 7 – 10 days
- Walk unassisted and without a limp by 4 – 6 weeks
- Start running at 10 – 12 weeks
- Return to unrestricted sports participation or a labor intensive occupation at 3 – 4 months
Will I need to do physical therapy following hip arthroscopy?
Absolutely. Physical therapy is critical to ensure that you get the best outcome from your surgery. With the guidance of your therapist, you will progressively advance through the various stages of your rehabilitation, as outlined in our post-operative protocol. Your therapist will have some flexibility to safely modify your progression in order to meet your specific goals and expectations.
Will I need to wear a brace after hip arthroscopy?
The use of a post-operative brace is not supported by the scientific literature. All of the available braces on the market are expensive, bulky, and cumbersome to wear. Given these significant drawbacks, Dr. Garabekyan feels that the marginal theoretical benefit of providing added stability to the hip during the healing process does not justify routine use of a brace. It is also worth mentioning that most hip arthroscopists in the United States do not use a post-operative brace.
How successful is hip arthroscopy?
The vast majority of scientific studies have produced good to excellent outcomes in 80 – 95% of appropriately selected patients undergoing hip arthroscopy; with some studies reporting lasting benefits for up to 10 years post-operatively. However, given that hip arthroscopy is a new and evolving subspecialty in orthopaedics, we do not yet have long-term outcomes extending beyond 10 years to know if these benefits are sustained. The reproducibility of these results is dependent on many factors. Dr. Garabekyan will help you understand your unique condition and what you stand to gain with surgery, so that you can define realistic goals and expectations. At SCHI, your satisfaction is our priority.
Am I a good candidate for hip arthroscopy?
Whether hip arthroscopy is a worthwhile option for you depends on a number of factors, including:
- Your age
- Your particular diagnosis or pattern of injury
- The extent of arthritis or cartilage damage
In general, the outcomes of hip arthroscopy are best in patients < 40 years of age with focal or discrete structural damage and minimal arthritis. Dr. Garabekyan will guide you through the various considerations in helping you decide whether hip arthroscopy is right for you.
Choosing the treatment option that is right for you involves careful consideration of your diagnosis, duration and severity of symptoms, desired level of activity, as well as social and financial elements. You are not alone in this process.
As you research your condition, please write down all of your questions and bring them with you to your next appointment. Dr. Garabekyan and his team at SCHI will take time to address all of your concerns, until you are completely satisfied with your treatment plan.
We look forward to helping you get your life back.