Conditions & treatments covered

There are a number of general and specific hip conditions that our consultants have experience in treating. These include: femoroacetabular impingement (FAI), hip osteoarthritis and groin pain. All patients will attend an initial consultation in order for a diagnosis to be established.

Once your consultant has made a diagnosis of the cause of your hip pain they will advise a way of directly treating your condition.

Non-Surgical Treatment

In some cases a physiotherapy treatment plan can be designed to help manage the symptoms and return you to your pre-injury level of activity. This will consist of several elements including a program to increase strength, regain mobility and range of movement. The physiotherapy team will help you reach your objective this by setting achievable goals.

Surgical Treatment

 There are various surgical options available, some of which are described in more detail in this section. 

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

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.

If you develop long-lasting hip pain that can’t be relieved with medication, and it continues to affect your life, your doctor might recommend a hip replacement. Hip pain can develop for several reasons, including different types of arthritis, a hip injury or a fracture after a fall.

During a hip replacement, sometimes called total hip replacement or hip replacement surgery, your doctor will remove the ball component of your hip joint at the top of the femur, along with any damaged cartilage and bone in the socket. Your hip joint is then replaced with an artificial (prosthetic) one.

There are many variations in the design of the prosthesis, and they can be constructed from metal, ceramic or plastic.

For most hip replacement you are likely to need to stay in hospital for a few days after the operation.

After surgery our physiotherapy team will be encourage you to stand up and walk with the help of crutches. They will also give you exercises to perform to help strengthen your hip and legs.

Sportsman's Groin

Sportsman's Hernia is also known as "Gilmore's groin". Athletes report a gradual onset of pain in the groin at the end of a game/training session, but initially without it affecting their level of performance. However, activities such as sprinting or kicking a ball soon become painful. Coughing and sneezing cause typical discomfort.

The groin canal (inguinal canal) connects the inside with the outside of the abdomen and is an opening in the stomach muscles that contains the spermatic cord. The canal is like a tube with 4 sides: front layer (external oblique fascia), back layer (posterior wall), medial layer (straight abdominal muscles) and lateral layer (inguinal ligament).

There is, however, an anatomical difference between a classic hernia (inguinal hernia) and a sportsman's hernia.

Classic or Inguinal Hernia

This is the more common type of hernia. There are two types: Indirect inguinal hernia and direct inguinal hernia. With an indirect hernia the normal opening in the stomach muscles is enlarged allowing fat to protrude. When the opening is large enough, even part of the intestine can protrude. With a direct inguinal hernia there is a tear in the posterior wall of the groin canal. With either type the patient might notice a lump in the groin area.

Sportsman's Hernia

This is a tear in the front layer (external oblique fascia) of the groin canal combined with a weakness in the muscle that forms the posterior wall of the groin canal. There is however no visible lump or protrusion. This condition can occur in most sports. The diagnosis can easily be made solely with clinical examination, but ultrasound can provide additional information.

Treatment

Non-operative treatment of the sportsman's hernia is usually not successful. Some patients report improvement of their symptoms at rest, but the pain usually reoccurs when patients return to their sports activities.

Overall, there is a consensus that surgery is the best option to treat this condition. The surgery is performed with a minimal incision technique to repair and strengthen the torn structures. The surgery can be done as a day case or with over night stay. Following the surgery jogging is allowed after 7 to 10 days. Patients do core stability exercises combined with exercises to strengthen the adductors postoperatively. A return to sports is usually achieved after 4 to 6 weeks.

Many sportsmen and women will experience pain or discomfort of the groin or inner thigh throughout their sporting life. The adductor longus are muscles that help make up the inner thigh, so called as the main function of this muscle is to adduct the thigh.

These types of injuries can either be classed as acute or chronic.

Acute adductor injuries

An acute adductor strain usually occurs during sporting activities - kicking a ball or stretching a leg. A sharp pain is felt on the inside of the leg and bruising can occur. In the majority of cases the tissues tear where the muscle connects to the tendon (musculo tendinous junction). Ultrasound or MRI can be used to localise the tear and determine its extent.

Treatment of acute adductor injuries

Acute injuries are treated by relative rest. Ice packs and gentle stretching can be started shortly after. Once the patient is more comfortable, he can begin a strengthening and walking programme, followed soon after by a return to gentle running.

When the adductor longus tendon is torn away (avulsion) from its attachment on the pubic bone this can be indication for surgery. Adductor longus repair surgery consists of re-anchoring the tendon where it is has come away from the bone. This is done by a minimalist open approach, with a small incision to the inner thigh/groin.

When would I be able to return to training?

This depends on the anatomic location of the tear. A tear at the musculotendinous junction usually gives a return to sport between 3 to 6 weeks.

An avulsion of the tendon from the pubic bone takes longer to recover and will take between 8 to 12 weeks, regardless of whether it is treated conservatively or surgically. Although with conservative treatment the loss of strength can be a problem in certain types of sports activities, with surgery the strength of the muscle is always fully restored.

How do I prevent this type of injury?

For athletes conditioning during the preseason is very important. There are several studies demonstrating that the risk of an acute injury to the adductor muscles is 17 times less if the adductors are strengthened.

 

Chronic adductor Injuries

With a longstanding adductor problem there usually is a gradual onset of pain in the inside of the thigh. The pain can be felt where the muscle or the tendon attaches to the pubic bone or slightly further down by the musculotendinous junction. Activities such as sprinting and accelerating or even kicking a ball are painful.

Treatment of chronic adductor injuries and return to sports.

It is important to consider the level of the athlete. In most cases treatment consists initially of an adductor stretching and strengthening programme with a sport specialist physio. An MRI scan helps to determine the severity of the condition and in moderately severe cases, a single injection can successfully treat the problem. Surgical treatment is indicated for those cases which do not respond to conservative management.

Historically surgeons have cut the adductor tendon (tenotomy) to treat this condition, but lots of athletes were not able to return to sports because of loss of adductor strength.

Professor Ernest Schilders has developed a surgical technique that allows the vast majority of recreational and professional athletes to return to their pre-injury level of sports at around 6 to 8 weeks and without loss of strength. The adductor longus is partially released through a small incision made to the inner thigh. Our audit results for this technique demonstrate good/excellent satisfaction in the majority of the patients.

Professor Ernest Schilders and his team have established the adductor enthesis as the pain source in adductor longus dysfunction. Their pioneering work has established entheseal pubic cleft injections as the first-line treatment option in chronic adductor longus enthesopathy.

This image below shows the injection and in a high amount of cases where the injection is undertaken open surgery may not be necessary.

Further reading relating to the Pubic Cleft Injection can be found in Professor Schilders published articles:

'Adductor-Related Groin Pain in Competitive Athletes. Role of Adductor Enthesis, Magnetic Resonance Imaging and Entheseal Pubic Cleft Injections'

'Adductor-Related Groin Pain in Recreational Athletes. Role of Adductor Enthesis, Magnetic Resonance Imaging and Entheseal Pubic Cleft Injections'

Both articles located on www.jbjs.org

Including:

  • Loosening
  • Fracture
  • Bone loss
  • Infection

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