Orion - Hip Arthroscopic Surgery

Experiencing pain in the hip

The hip is a ball and socket joint. The call (femoral head) and socker (acetabulum) are shaped and positioned so that you have a painless and flexible range of motion without any instability. The edges of the socket are also lined by a rubber-like structure called the labrum; it helps cushion the joint and acts like a rubber seal to hold the ball securely within the hip joint itself.

Tears of the labrum can occur as a result of sporting injuries or developmental conditions (FAI femoral acetabular impingement). Athletes involved in sports where they are often in a mid-squat position like hockey and tennis may develop labral tears. It may manifest as pain in your hip or groin that is worse with walking or sitting. Some patients experience a clicking or catching sensation in their groin as they move their hip.

Please seek medical help if you have any of these symptoms. Your orthopaedic surgeon will take a detailed medical history from you, perform a thorough medical examination and likely organise an MRI scan of your hip to confirm the labral tear.

FAI femoral acetabular impingement

FAI describes a developmental condition where structural abnormalities in their hip accelerates wear and tear; this may eventually lead to early hip arthritis. There are two main types of FAI, CAM and pincer types.

The CAM type of FAI occurs due to an extra bump of bone at the junction of the femoral head and neck. This extra bone collides or impinges on the labrum when the hip is moved around. Imagine having a small stone in your shoe! The soft labrum is therefore squeezed between the bony acetabulum and bony bump and ends up tearing. If the bony bump is not removed and the labrum is not repaired, the hip will become arthritic sooner than later.

The pincer type of FAI occurs when there is overhanging or extra bone around the acetabulum. As the hip is moved, the pincer crushes the soft labrum against the hard femoral neck, resulting in a badly damaged labrum and painful hip. Some patients have a combined CAM and pincer which makes their symptoms worse.

Arthroscopic labral repair

Many years ago, repair of the labrum involved open surgery where a large skin incision was made. These days arthroscopic or keyhole surgery is performed for the same purpose. Small incisions allow wounds to heal faster, lower the risk of infection and reduces the collateral damage to other structures in the hip. Several incisions about 1 or 2cm long are made around your painful hip. The instruments used for this procedure are long and thin like chopsticks. It allows accurate localisation of the torn labrum and precise repair of the tear. Labral tears should also not be repaired in isolation. The offending CAM bony bump or overhanging pincer must be addressed to prevent repeat tears in future.

Rehabilitation after surgery may take 3 to 6 months. In the early days after surgery, medication is given to manage general pain around the hip, ice is applied to reduce swelling and patients are not allowed to bend their hips beyond 90 degrees to protect the repair site. While the arthroscopic scars are small and heal in 2 weeks, patients need to go for frequent physiotherapy after surgery to prevent scarring in their hips, maintain muscle strength in the thighs and promote smooth a walking pattern. Cycling on a stationary bicycle is important to get your hips going to prevent stiffness. Most patients return to brisk walking at about 3 months and sports at 6 months.

The intention of hip preservation surgery is to repair and patch up the hip injuries and delay the need for a formal hip replacement. There is a chance that damage in the hip is too advanced and patients continue to have pain despite hip preservation surgery. In these cases, we would counsel patients for a total hip replacement so that they may return to their active lifestyles again. It is not true that only elderly patients receive a total hip replacement and it is not true that you cannot be active after hip replacement surgery. Do speak to us if you have been bothered by your hip pain. We are equipped with a spectrum of non-surgical and surgical techniques to help you with your symptoms.

Procedures

Hip Arthroscopic Surgery

Experiencing pain in the hip

FAI femoral acetabular impingement

Arthroscopic labral repair

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