Hip Arthroscopy / "Hip Preservation Surgery"
What are the indications of the procedure?
Hip arthroscopy is typically indicated for early arthritic conditions of the hip, so- called Hip Impingement, sporting injuries resulting in hip labral tears, loose bodies in the hip, hip inflammation (“hip synovitis”), or psoas tendinopathy resistant to other non-operative treatment. Whether of not hip arthroscopy can help in patients with moderate hip arthritis is the subject of ongoing research.
What does the above entail?
Hip Arthroscopy is a key-hole procedure, which is performed under General Anaesthetic or Epidural Anaesthesia with sedation. You are placed in a traction table which allows safe and controlled distraction of the hip joint. This facilitates examination of the hip joint safely, visualising the cartilage surfaces. The soft cartilage ‘labrum’ is examined and probed. Tears are repaired using ‘anchor sutures which are drilled into the socket safely and under direct vision. Excess bone causing hip impingement is carefully and slowly trimmed. Careful assessment during the procedure ensures that adequate but not too much bone is removed.
Length of Stay for hip arthroscopy
Overnight stay to facilitate physiotherapy treatment, including massage, safe mobility with crutches (usually 3 weeks, may be shorter or longer) and to ensure pain levels are controlled.
Time off work
Typically 3-4 weeks. More than anything else it allows optimal rehab and exercise under the expert supervision of physio colleagues.
Typical recovery time
4 phases of recovery- from partial weight bearing to sport specific physiotherapy takes on average 3-4 months to achieve, and varies according to the underlying diagnosis, and time from presentation to surgery.
Risks of surgery
Infection, numbness due to compression or stretching of nerve fibres, stiffness, clots (thrombosis), a small chance in patients with arthritis of persistent symptoms/progression of OA (5% risk quoted).
Hip Replacement Surgery
What does this involve?
An operation under spinal/epidural anaesthesia with sedation, incision around your hip, replacement of the arthritic hip with a patient specific implant, length of stay typically 3 nights.
Benefits/Risks?
Usually significant improvement in pain, function, quality of life and mobility. Risks include infection, clots (thrombosis), dislocation, leg length difference ), revision because of subsequent wear and loosening and a smallmortality risk. Various measures are put in place (injections, stockings, etc) to reduce the risks of the above.
Time to full recovery
Variable, may be very quick in some patients, in others 6-9 months before the full benefit of the procedure is experienced.
KNEE CONDITIONS and KNEE SURGERY
What does this involve?
Knee arthroscopy is typically a day case procedure. The procedure is performed under general anaesthetic, usually 2-3 small incisions are made around the knee, and a camera is placed inside the knee to visualise the structures in the knee. The intended procedure is perfomed, for example, trimming or repair of the meniscus (cartilage), and washout of the knee. Local anaesthetic and viscosupplementation (‘viscoseal’) is frequently injected into the knee after the procedure for pain relief.
What are the benefits of the procedure
Knee arthroscopy is commonly performed for torn cartilage (‘meniscal tears’) in the knee. Arthroscopic trimming aims to improve your symptoms (pain, clicking, swelling, locking). The extent of your improvement depends on a number of factors, such as the extent of the tear, the type of tear, length of time before receiving treatment, any associated arthritic changes in the knee and how well you rehabilitate with physiotherapists after your operation.
What are the risks of the procedure?
According to British Orthopaedic Association guidelines, the following are risks of the surgery: Infection, swelling, persistent pain, damage to skin or structures within the knee, damaged instruments, abnormal wound healing, numbness, blood clots. In practice, the commonest risks are infection, swelling, persistent pain (often due to the underlying pathology e.g. pre-existing arthritis in the knee), that surgery may not help, and in certain cases (again when there is pre-existing arthritis) that symptoms may worsen after surgery and a small risk of blood clots. It is my preference to mobilise you quickly and use TED stockings as a matter of routine, to reduce the risks above.
Time off work / sports
Variable, depending on your occupation, but my preference is 2 weeks off work if possible to allow you to recover from the procedure, but also to concentrate on your physiotherapy. Return to sports again depends on your underlying diagnosis, it may be 3-4 months before you return to your chosen sporting activity.
Time back driving a car?
Usually 5-7 days.
Anything else I need to know?
Very occasionally, other pathologies apart from what was identified clinically or using imaging (MRI scan) is identified. These pathologies include a loose fragment of hard cartilage (osteochondral fragment) or a torn ligament. If it’s possible, it’s desirable to proceed with another procedure (e.g. microfracture) at the same time to avoid another procedure, but that is not always possible. However, the recovery time would be different if your surgeon proceeds with treatment of the unexpected pathology. Please let your surgeon know if you do not wish to have a different procedure from what was discussed.
Anterior Cruciate Ligament (ACL) Reconstruction
When is Anterior Cruciate Ligament Reconstruction indicated?
Complete ruptures of the anterior cruciate ligament will not heal. If you have an active lifestyle, enjoy sports and continue to have knee instability/giving way, ACL reconstuction is indicated to restore kne stability and minimise the risk of futher injury to your knee.
What are the operative options?
There are several options, but the most commonly utilised surgical techniques are the use of hamstrings or bone patellar tendon bone to reconstruct the ACL.
What is required in order to ensure a good outcome from surgery?
Key to the success of ACL reconstruction is understanding that physiotherapy and compliance with exercises for many months (at least 6-9 months) after surgery is fundamental to a successful outcome. It is important that you are cared for by experienced physiotherapists who are familiar with an accelerated rehabilitation protocol following surgery.
Partial knee replacements
When are partial knee replacements appropriate?
Partial knee replacements, whether or not it is partial knee cap or partial knee replacement of the inside of the knee “unicondylar knee replacement” is ideal for the patient who has advanced, but localised arthritis of the knee where non operative measures have failed in managing your symptoms.
Advantages of partial knee replacements?
The advantages of partial knee replacement are that it is a relatively smaller operation compared to a total knee replacement, the main muscle of the knee (quadriceps) is relatively preserved when performing the procedure, hence it is a less painful operation with a quicker recovery from the procedure. Bone stock is preserved which is particularly important if you are a young patient, as wearing of any implant over time will necessitate a further operation in the future.
What happens if arthritis in the rest of the knee progresses?
If arthritis in the rest of the knee progresses, early re-do/ revision surgery may be required. Partial knee replacements are not as commonly performed as full or total knee replacements. As all knee operations are highly technical procedure, you must ensure your surgeon is adequately trained, competent and sufficiently experienced in performing partial knee replacements.