Hip arthroscopy is the term used for keyhole (endoscopic) surgery of the hip. It is a surgical procedure that has been around over the past twenty years, but has only recently gained popularity because of advancement in surgical techniques and wider understanding of hip pathology.
A hip arthroscopy is a minimally invasive procedure used to evaluate and treat certain disorders of the hip. It is an alternative to open surgery where longer recovery periods are expected. Hip arthroscopy has helped in offering treatment for conditions that previously went unrecognised including labral tears, cartilage injuries and ligamentum teres disruptions.
This arthroscopic procedure is performed on an inpatient basis with a stay of up to 1 night. Patients receive a general anaesthetic. Small incisions are then made in the patient's hip area and a camera lens is inserted through these holes so that the surgeon may visualise the inside of the hip joint. The following conditions are commonly treated arthroscopically:
Treating Femoroacetabular Impingement
FAI is treated by reshaping of the femoral neck (femoral osteoplasty), trimming down of the pincer deformity, repair of labral tears and cartilage lesions. This was first done as an open surgical dislocation of the hip.
The advantage of an arthroscopic technique is that it is less invasive and offers fast recovery. Professor Schilders has a 92 % return to sports following hip arthroscopy. If osteoarthritis is already present a less positive outcome has to be expected.
Arthroscopic repair of labral tear
Most of the labral tears are in the interval between the labrum and articular cartilage of the acetabulum. This is an area with a relatively poor bloodsupply and, consequently, with a low potential for spontaneous healing of the tears. Labral tears can be repaired arthroscopically. The torn labrum can be refixated with suture anchors to the rim of the acetabulum. The labrum takes about 3 months to heal. We find labral tears predominantly with impingement (FAI), but also with hip dysplasia, hip instability, post-traumatically and in degenerative hips. Our early results demonstrate that patients who have had a labral repair, do better from a pain and function perspective after 2 years than those who have had a labral resection. The surgeons of the London Hip Arthroscopy Centre have the largest labral repair experience in the country.
Hydrotherapy is the application of physiotherapy techniques in water and can be a very useful adjunct to rehabilitation following hip arthroscopy.
The following protocol has been designed as a guide for patients and physiotherapists to use following hip arthroscopy.
Hydrotherapy can be started as soon as wounds have healed (10-14 days). We strongly advise that you consult your physiotherapist before starting hydrotherapy in order to select the exercises most appropriate to your rehabilitation.
Key points to remember when doing hydrotherapy
- The buoyancy of the water offloads the body weight from the hip joint which can make moving in the water easier. However it is therefore easy to aggravate acute pain without realising it, and so you may feel your hip is more sore after treatment. We therefore recommend you limit time in hydrotherapy for 10-15 minutes to start with, even if you feel like you are able to do more while in the pool, and gradually increase as your hip pain allows.
- Remember to maintain a correct posture in the hydrotherapy pool to avoid injury to your back and hip whilst exercising. To do this engage your lower abdominal muscles, keep your shoulders relaxed and try not to slouch.
Hydrotherapy at The Wellington Hospital
The Wellington Hospital offers hydrotherapy following hip arthroscopy in one-to-one sessions with our Senior Physiotherapists at our on-site hydrotherapy pool.
Prior to treatment, all patients undergo a thorough land-based assessment to establish strengths, weaknesses and aims of treatment. Each patient is prescribed a comprehensive, evidence based treatment plan tailored to their individual needs.
The Hydrotherapy department at The Wellington Hospital strives to provide an efficient and effective service. Our Physiotherapy Assistants are poolside throughout the treatment session to assist patients in and out of the pool and help as needed. Towels, bathrobes and complimentary shower gel and shampoo are also provided.
For more information or to discuss referrals, please contact the physiotherapy department on 0207 483 5184.