Hip Surgery

What is Hip Surgery?

Hip surgery is a surgical procedure for the treatment of a hip injury or hip condition. The procedure involves repairing diseased or damaged structures of the hip joint in order to eliminate pain and restore normal hip function.

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. Stability of the hip joint is achieved by the labrum, ligaments, and tendons that encase the hip and support hip movements. Any damage to these structures may warrant a hip surgery.

Indications for Hip Surgery

Hip surgery is indicated when non-surgical treatment such as medications, injections, physical therapy, closed reduction and manipulation have been unsuccessful in treating hip conditions such as:

• Arthritis: Degenerative joint condition that causes the cartilage, the tissue that cushions and protects the ends of bones in a joint, to wear off, causing painful rubbing of the bones
• Femoroacetabular impingement (FAI): Friction in the hip joint from abnormal bony irregularities 
• Hip dislocation: Head of the femur moves out of the socket
• Hip dysplasia: Congenital hip condition characterised by a shallow acetabulum 
• Labral tear: Tear or separation of the labrum, a cartilaginous ring that surrounds the socket and seals the hip joint
• Avascular necrosis: Disrupted blood flow to the hip joint, causing death of bone tissue
• Hip fracture: A break in the hip bone as a result of a high-energy trauma or bone weakness.

Preparation for Hip Surgery

Preoperative preparation for hip surgery will generally involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the surgery.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Hip Surgery

Several types of hip surgeries can be performed based on your hip condition. Hip surgery is usually performed under general or local anaesthesia either as an open surgery or as a minimally invasive arthroscopic procedure.

In an arthroscopic procedure, tiny incisions (portals), about a half-inch in length, are made around the hip joint area. Through one of the incisions, an arthroscope - a small flexible tube with a light and video camera at the end - is passed into the joint. The camera attached to the arthroscope displays the images of the inside of the joint on a monitor, which allows your surgeon to view the damage and carry out the required repair.

In an open surgery, a long incision of several centimetres is made over the hip joint. The underlying soft tissues are carefully moved aside to expose the treatment area. Special surgical tools are used to carry out the required repair around the joint. Once the repair is complete, the instruments are removed and the incisions are closed with stitches or small sterile bandage strips.

Some of the common hip surgeries include:

• Hip labrum repair: This is a surgery employed for the treatment of a torn hip labrum. A hip labral tear is an injury to the labrum, the cartilage that surrounds the outside rim of your hip joint socket. The labrum helps to deepen the socket and provide stability to the joint. It also acts as a cushion and enables smooth movement of the joint. During hip labrum repair surgery, your surgeon repairs the torn tissue by sewing it back together or removes the torn piece all together, depending upon the cause and extent of the tear.
• Hip labrum reconstruction: In some instances, where the hip labrum tear is severe and repair is not possible, your surgeon may perform a surgery called hip labrum reconstruction. In this surgery, a tissue graft is obtained from your own body (autograft) or a donor (allograft) and the graft is secured to the remaining part of the labrum utilising durable stitching.
• Surgery for snapping hip syndrome: Snapping hip syndrome is a condition in which you hear or feel a snapping sound in the hip when you swing your legs, run, walk or get up from a chair. The movement of muscles or tendons over a bony protrusion in the hip region or the presence of loose body fragments such as fragments of bone or cartilage in the joint space can give rise to the snapping sound. Common surgeries for snapping hip syndrome include:
  • Iliotibial band release: This procedure involves lengthening of the iliotibial band to decrease tension and hip snapping.
  • Iliopsoas tendon release: This procedure involves lengthening of the iliopsoas tendon to decrease muscle tension and hip clicking.
  • Arthroscopic hip debridement: This procedure involves making small incisions at the hip joint cavity and removing bone or cartilage fragments.
• Femoral osteoplasty: This is a surgery to correct femoroacetabular impingement (FAI), a condition characterised by excessive friction in the hip joint from the presence of bony irregularities, which damages the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket). During femoral osteoplasty surgery, your surgeon removes excess bone from the femoral neck to make enough room for free motion of the hip joint, as well as repair any labral tears or cartilage damage caused by impingement.
• Periacetabular osteoplasty: This is a surgery to correct hip dysplasia. Hip dysplasia is a condition that is seen in infants and young children as a result of developmental problems in the hip joint. The femur (thigh bone) partially or completely slips out of the hip socket causing dislocation at the hip joint. During periacetabular osteoplasty surgery, your surgeon trims the hip socket (acetabulum) so that the femoral head can be repositioned in the pelvis, inserts metal screws into the bone to stabilise it in the new position, and smooths out any bone deformities that may be causing pain.
• Surgery for avascular necrosis: Avascular necrosis, also called osteonecrosis, is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Avascular necrosis can be treated by one of the following methods:
  • Core decompression: During this procedure, a portion of the inner layer of the bone is removed to relieve the pressure inside the bone. This decreases the pain and allows the growth of new blood vessels; thereby, stimulating new bone growth.
  • Bone transplant: Healthy bone harvested from another part of your body is grafted into the affected area.
  • Bone reshaping (osteotomy): This procedure is performed in advanced stages and involves reshaping of the bone which is done to decrease the stress placed over the affected bone.
• Total hip replacement: This is a surgery commonly employed for the treatment of hip joint arthritis or damage to the hip joint as a result of severe trauma or fracture. In this surgery, the damaged articulating parts of the hip joint are removed and replaced with artificial prostheses to restore normal hip function.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after hip surgery will involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
• You may notice some pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualised physical therapy protocol will be designed to help strengthen hip muscles and optimise hip function.
• You will be able to resume your normal activities in 3 to 4 weeks after surgery; however, you may have certain activity restrictions, and return to sports may take at least 6 months or longer.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Hip surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Damage to nerves and vessels
• Thromboembolism or blood clots
• Hip instability
• Joint stiffness
• Leg length discrepancy
• Dislocation
• Re-rupture of the repaired tendon
• Hardware failure
• Graft failure
• Need for additional surgery