Common Hip Injuries We Treat
PROXIMAL HAMSTRING TENDON RUPTURE INFORMATION PACKET
Rupture of the proximal hamstring tendon is a relatively rare injury and is caused by a traumatic incident, such as falling or water skiing. A complete rupture, meaning the tendon is completely pulled off the bone, can be treated with conservative treatment which includes rehabilitation (physical therapy) or surgically. Depending on the acuteness of the injury and your hobbies and goals, your doctor may recommend one treatment option over the other. Patients treated non- operatively (meaning with physical therapy and no surgery) can do fairly well in the appropriate setting. However, there is usually about a 20% decrease in strength and function in that
hamstring after this type of injury. Patients who want to return to high level sports or that are very active usually opt for surgery. It is best to have the surgery done within the first three weeks after the injury if possible, before scar tissue develops around the retracted tendon.
Surgery is done through an open incision along the crease of your buttock. Two to three anchors are inserted into ischial tuberosity (where the hamstring used to attach) and from these anchors are sutures. These sutures are sewn into the end of the detached tendon and pulled back up to the bone and the sutures are tied. The sutures can withhold some force but the outcome of the surgery is dependent on your body’s ability to heal the tendon back down to the bone. This takes about 12 weeks.
After surgery, you will need a hip brace which will prevent you from being able to flex at the hip. You will be in this brace for about 4 weeks. You will be fitted for this brace prior to surgery and you must bring this brace with you the day of surgery. Please review the FAQs below for more information on what to expect after surgery.
FREQUENTLY ASKED QUESTIONS: PROXIMAL HAMSTRING REPAIR
When do I have to wear the brace and for how long?
The brace must be worn at all times except for bathing and dressing. At the initial post- op appointment further brace wear will be addressed. The brace should be worn as directed by the doctor, usually for about 4 weeks.
How long will I need to be in Physical Therapy?
This is variable and depends on the patient. In general, you should expect to be in PT for about 3-6 months. The specific PT program and goals will be per Greater Michigan Orthopedic'sprotocol. You will be provided with a prescription for PT and you can choose a facility that is a convenient location for you.
When can I drive?
You may not drive while wearing the brace so you should plan on not driving for at least the first 4 - 6 weeks if it is your left leg (2 months if you drive a standard transmission) and at least 2 months if it is your right leg.
How do I go to the bathroom?
Going to the bathroom may be difficult. Please do the best you can with the brace left on. Some patients find a high commode to be useful. If your insurance will pay for one then arrangements can possibly be made prior to discharge from the hospital to obtain one.
What signs should I look for that is suggestive of a blood clot?
Although a blood clot is unlikely if you are taking the blood thinner as prescribed, it is not impossible. If you develop ANY calf pain/swelling or shortness of breath
please contact our office immediately
What signs should I look for that is suggestive of an infection?
Infection is not a common complication after this surgery but if you develop a fever of >102 degrees or if there are signs of spreading redness or increased tenderness around the incision or any drainage (other than blood) through the bandages then please contact our office immediately at 810-953-0500.
When will I see the doctor again?
You should be seen 10-14 days after surgery. A follow-up visit should already be
scheduled for you. If not, please call our office to schedule this.
POST-OPERATIVE INSTRUCTION SHEET: PROXIMAL HAMSTRING REPAIR
POST-OP MEDICATIONS:
• You were given a prescription for pain medication prior to discharge. This medication may be taken as directed. Once the pain or discomfort is minimal, you may switch to over-the-counter medications, such as Tylenol.
• You should take a stool softener for the first 4 weeks. The pain medication can cause significant constipation. Peri-Colace can be purchased over-the-counter and taken twice daily.
• Anti-coagulation is critical to minimize the risk of a DVT (or blood clot). You will be given a blood thinner daily as a precaution.
ICE:
• Ice bags (not directly touching the skin) should be utilized to reduce swelling and pain.
Please ice every 3-4 hours for about 15-20 minutes each time for at least the first 5 days
or until swelling subsides.
• Do not put ice directly on your skin.
BRACE:
• You have been fitted for a hip brace. This must remain on at all times for at least the first 4 weeks or until otherwise directed by the doctor. It should only be removed for dressing and bathing purposes. This brace is essential in preventing any stress on the tendon repair.
AMBULATION:
• Toe-touch weight bearing after surgery with two crutches. Further weight-bearing instructions will be provided to you at your first post-operative visit.
WOUND CARE:
• Leave your surgical dressing on until your first post-operative visit.
• Do not get your dressing or incision wet. It is best to sponge bathe or use a hand held shower device until your dressing has been removed. Please call our office if there is draining or bleeding through your dressing.
FOLLOW UP VISIT:
• If you do not already have a follow-up visit scheduled then please call 810-953-0500 to schedule one within 10-14 days.
REHABILITATION PROTOCOL for PROXIMAL HAMSTRING REPAIR
PHASE I: 0 to 4 Weeks
Goals:
• Protect the repair
Weight bearing:
• Toe-touch weight bearing with hip orthosis on at all times
• May take off for showering
Treatment Plan:
• Ice for pain and swelling control 3-5 times per day
• Teach patient how to transfer from supine to sitting positions and standing to sitting positions safely and with brace on
• Heel props with quad sets in the supine position (to prevent knee stiffness and promote quad control)
PHASE II: 4 to 8 Weeks
Goals:
• Normal gait is restored
• Pain free ADLs
Weight bearing:
• Progress to full weight bearing and wean off crutches and out of brace
Treatment Plan:
• Improve ADL function- stand, stairs, walking, etc
• Start gentle ROM
• Emphasize restoring normal gait pattern
• Desensitization massage over the incision
• WEEK 4 begin active ROM of knee and hip
• Begin Total Leg Strengthening
- Heel raises
- Quad sets (active heel lift)
- Short arc quads
- General hip strengthening (abduction/adduction) while lying on side
- Single leg balance for proprioception
• NO HAMSTRING STRETCHING
PHASE III: 8 to 12 Weeks
Goals:
• Perform non-impact aerobic activities without pain
• Perform ADLs at home and work without restrictions
Treatment Plan:
• Core training
• Isotonic exercises avoiding terminal ranges of motion
• Begin aerobic conditioning
- Stationary bike
- Stairmaster
- Elliptical trainer
• Progress Total Leg Strengthening
- 1/4 squats
- Step downs
- Leg press
- Knee extensions
- Heel raises
- Standing hip abductor strengthening (or use machine)
- Balance and proprioceptive training
PHASE IV: 3 to 6 months
Goals:
• Return to recreational activities and sports
Treatment Plan:
• Progress to terminal ROM
• Begin hamstring strengthening
• Continue balance and proprioception retraining
• Progress Total Leg Strengthening
- Advanced step down
- 1/4 to 1/2 squats with hand held weights
- Straight leg raises with ankle weights
- Closed kinetic chain hamstring strengthening
• Advance to light land jogging at 5-6 months
• Progress back to competitive sports once strength is 75-80% compared to contralateral side
Hamstring Strain
ANATOMY
There are three muscles in the back of the thigh that are collectively called the hamstrings. They are named biceps femoris, semitendinosis and semimembranosis. The two attachment sites for the hamstrings are the ischial tuberosity (the bony prominence felt
under each buttock when sitting), and the back of the knee at the tibia (shin bone). Contraction of the hamstring can cause the knee to flex, bringing the heel toward the buttock. The hamstrings also cause the hip to extend the thigh backwards when the knee is
straight. The hamstring muscles provide control to the pelvis when bending forward with the knees straight.
When walking or running, the hamstrings function to decelerate the leg and foot as it rapidly moves forward to land on the ground.
INJURY
A hamstring strain is an excessive stretch or tearing of muscle fibers and related tissues. Hamstring strains can occur at one of the attachment sites or at any point along the length of the muscle. They are classified as either1st, 2nd, or 3rd degree, with a grade 3 hamstring stain being the most severe.
A pulled hamstring muscle most commonly presents as a sudden pain in the back of the thigh during fast running or sprinting, when there are great force demands on the muscle. Although hamstring strains often occur while sprinting, they also can occur during jumping and other activities where quick starts
and stops are required. High risk sports for hamstring strains are: soccer, football, rugby, baseball, basketball, water skiing and many track and field events. Runners are especially susceptible to chronic hamstring strains due to the repetitive nature of the sport.
Also, when there is an imbalance of the strength of the hamstring muscles with relation to the quadriceps muscles, the risk of hamstring strain is greater.
Severity of Muscle Strains. Muscle strains are graded as mild, moderate and severe. The more
severe the strain, the longer the time to recover.
First Degree (Mild). This injury is the most common and usually the most minor. This injury is a ‘pulled muscle’ with a structural disruption of less than 5 percent. With a first-degree injury, you can expect to be back to sports within 1 to 3 weeks.
Second Degree (Moderate). This injury consists of a more significant, but still incomplete muscle tear. This a partial muscle tear and require 3 to 6 weeks of rest and recovery before you can return to full activity.
Third Degree (Severe). This injury results in complete tearing of the muscle–tendon unit. A third-degree muscle strain can take many weeks or months to fully heal.
TREATMENT
Rest from the activity that caused the muscle strain allows for healing to occur. Immediately following the muscle strain, ice should be applied over the painful area for 20 min. Periodic icing (2-3 times per day) will help to control swelling and reduce pain. Heat should not be applied to the area during the first 7-10 days since this may increase swelling and bleeding within the muscle. An elastic wrap or compressive stocking may be applied to the area to assist with swelling control. If the compressive device causes increased discomfort or "pins and needles" in any part of your leg, it is probably too tight. Lying down periodically with your leg elevated allows gravity to assist with your effort to control the swelling.
Though some experts believe early stretching to be valuable, caution should be taken to avoid aggressive stretching (stretching beyond the point of mild discomfort) which may disrupt healing. NO stretching or resistive exercise should be done during the first 3 weeks following injury.
As a general rule of thumb, any activity that elicits pain at or near the injured site may be causing further injury and will only hamper your recovery effort.
A gradual conditioning program, specific to your sport, will prepare the hamstrings for the high demands placed upon them during athletics. Don't forget to incorporate a proper warm-up and stretching session into your conditioning program and athletic competition.
Rehabilitation Program
Exercises outlined in the rehabilitation program are described and illustrated in the back of the handout. The ‘time line’ that is illustrated in the following rehabilitation program is typical after grade 2 and 3 injuries. After a grade 1 injury, rehabilitation can usually begin at phase three.
Phase one - The first week after injury
• Rest from painful activities
• Ice 20 minutes, three times a day
• Compression wrap or neoprene sleeve
Phase two – the second and third week after injury
• Ice once a day, 20 minutes, after exercises
• Start active ROM exercises, 1-2 times a day, 10 to 20 repetitions
• Quad sets
• Heel slides (towel assist if painful)
• Toe raises
• Standing hamstring curls
• Standing or prone SLR hip extension
• Stationary bicycle, 10 minutes, no resistance, if pain free • NO stretching
Phase three – the 4th, 5th and 6th week after injury
Begin gentle strengthening, 1 time a day, 5 days a week, 15 to 30 repetitions
• Start 1lb ankle weight.
• Standing hamstring curls, add one pound a week to 5 pounds
• Standing or prone SLR hip extension, PRE one pound a week to 5 pounds
• Stationary cycle, add 1 minute per session up to 30 to 40 minutes
• Slow treadmill walking, pain free, start 5 minutes and add one minute per session to 20 minutes or start “Return to Walk\Run Program” (see below).
• Gentle pain-free stretching, two times a day (see stretching illustrations and instructions in the back of the handout).
Phase four – 7 to 12 weeks after injury
• Start gradual hamstring and quadriceps strength training, maintaining a 4:3 Hamstring: Quadriceps ratio, 3 times a week.
• Follow ‘Strength Training for the Knee’ supplement and Principles of Progressive Resistance exercise.
• Stationary cycle
• Gentle hamstring stretching
• Start “Return to Full Speed Running Program if able to jog 1 mile pain-free.
Phase five – from 12 weeks onward
• Continue above program
• Start return to sports training
Return to walk run program
General instructions
1. Walking/jogging should be done no more than every other day.
2. The program should be performed step by step. Do not advance your program until you can successfully complete the initial step. Let pain and swelling be your guide. If the activity creates pain,
swelling, or causes your to limp, go back to the previous step.
3. Before starting the program and after completion of the program, allow 15 minutes to preform warm-up and gentle stretching exercises.
4. Cool down by gently stretching all muscle groups.
5. Ice for 20 minutes after cool down stretching
PHASE 1
Day #1 Walk 1/4 mile—easy pace (1/2 speed)
Day #2 Walk 1/4 mile—(3/4 speed)
Day #3 Walk 1/4 mile—full speed (briskly)
PHASE 2
Day #1 Walk 1/2 mile—easy pace (1/2 speed)
Day #2 Walk 1/2 mile—(3/4 speed)
Day #3 Walk 1/2 mile—full speed (briskly)
PHASE 3
Day #1 Walk 3/4 mile—easy pace (1/2 speed)
Day #2 Walk 3/4 mile—(3/4 speed)
Day #3 Walk 1 mile—comfortable pace: 3/4 full speed
PHASE 4
Day #1 Jog 1/4 mile, Walk 3/4 mile, comfortable pace
Day #2 Jog 1/2 mile, Walk 1/2 mile, comfortable pace
Day #3 Jog 3/4 mile, Walk 1/4 mile, comfortable pace
PHASE 5
Day #1 Jog 1/4 mile, Walk 3/4 mile, comfortable pace
Day #2 Jog 1 mile
Day #3 Jog 1 mile
You can continue to increase your distance by 1/4 mile per session until you reach your desired distance. When you have reached your training distance without causing any pain or swelling, and have a normal running form, you can gradually start to increase your running speed and distance.
Post Operative Hip Arthroscopy Rehabilitation Protocol for
Post Operative Hip Arthroscopy Rehabilitation Protocol for
Labral Repair With or Without FAI Component
Date of Surgery:
ROM Restrictions:
-Perform PROM in patient’s PAIN FREE Range
PHASE 1
Goal: Protect the Joint and Avoid Irritation PT Pointers:
-Goal is symmetric ROM by 6-8 weeeks
-NO Active open chain hip flexor activation
-Emphasize Proximal Control
-Manual Therapy to be provided 20-30 minutes/PT session
PHASE 2
Goal: Non-Compensatory Gait and Progression PT Pointers:
-Advance ambulation slowly without crutches/brace as patient tolerates and avoid any compensatory patterns Provide tactile and verbal cueing to enable non-compensatory gait patterning
-Advance exercises only as patient exhibits good control (proximally and distally) with previous exercises
-If MicroFracture was performed, Hold all weight bearing exercises until week 6
PHASE 3
Goal: Return the Patient to Their Pre-Injury Level PT Pointers:
-Focus on more FUNCTIONAL exercises in all planes
-Advance exercises only as patient exhibits good control (proximally and distally) with previous exercises -More individualized, if the patients demand is higher than the rehab will be longer
Phase 4
Goal: Return to Sport PT Pointers:
-It typically takes 4-6 months to return to sport, possible 1 year for maximal recovery -Perform a running analysis prior to running/cutting/agility
-Assess functional strength and obtain proximal control prior to advancement of phase 4
Hip Abductor (gluteus medius) Repair
Hip abductors are a major group of muscles found in the buttocks. They include the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.
Gluteus medius is situated on the outer surface of the hip. The function of the gluteus medius is to assist with pelvis stability, hip abduction, along with internal and external rotation of the hip. Tears of the gluteus medius usually occur where the tendon inserts at the greater trochanter, causing lateral hip pain.
Tears of the gluteus medius can occur due to traumatic injury or degenerative conditions such as tendinopathy (chronic inflammation of the gluteus medius tendon). Gluteus medius tears cause pain and weakness on
the affected side of the hip. One of the main symptoms of a gluteus medius tear is the presence of Trendelenburg sign–dropping of the pelvis towards
the unaffected side by being unable to bear weight on the affected limb. The diagnosis of gluteus medius tear is based on physical examination of the
patient, followed by palpation of the affected muscle, testing muscle power and assessing walking pattern or gait of the patient. Certain special tests such as single-leg squat test or a positive Trendelenburg sign confirm the diagnosis of gluteus medius tear. Sometimes, MRI or ultrasound may be helpful to show the pathological changes of the muscle.
Treatment
The aim of treatment is to restore the normal function of the gluteus medius tendon.
Immediately following the rupture of the tendon, you should do the following:
- Rest your hip by refraining from activities until it is healed.
- Apply ice to your hip to reduce pain and inflammation caused by injury.
- Elevation involves keeping the affected hip raised above your heart to minimize swelling.
Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or steroid injections may be given to reduce the pain and inflammation. Assistive devices such as a cane or crutch may be used temporarily to facilitate pain free ambulation.
Your surgeon may recommend physical therapy to strengthen the muscles and increase stability of the hip prior to any surgical procedure.
In addition, Injections, such as, Corticosteroids or PRP can be utilized to help your pain and function without a surgical procedure. Surgical treatment may be recommended to repair a complete, full-thickness
gluteus medius tear. The rupture can be repaired arthroscopically to help restore the strength and function of the gluteus medius.
Gluteus medius tendon ruptures can be repaired by open or arthroscopic technique.
The steps involved in open surgery include:
You will be placed either under general anesthesia or spinal anesthesia mThe surgeon makes a long incision in your hip. The underlying muscles and tissues are separated to expose the damaged tendon.
Arthroscopic surgery involves the following steps:
You will be placed either under general anesthesia or spinal anesthesia The surgeon makes two or three small incisions, about 1/4 of an inch each, around the hip joint area. Each incision is called a portal. A blunt tube, called a trocar, is inserted into each portal prior to the insertion of the arthroscope and surgical instruments. The arthroscope is inserted through one of the portals, to view the hip joint. The images from the arthroscope guide the surgeon and assist in detection of any anomaly. It also enables the surgeon to see the attachment of the gluteus medius muscle. The surgeon conducts a diagnostic endoscopic examination of the peritrochanteric space. The other portals are used for the insertion of surgical instruments.
The following steps are common for both open and arthroscopic surgeries:
Debridement of the tears on the under surface of the gluteus tendon and pathologic tendon tissue is performed using a shaver. The tear at the lateral facet of the greater trochanter is identified and removed using a bur to stimulate active bleeding which would aid in healing of the repaired tendon
The tendons are visualized and an anchor(s) is/are placed onto the greater trochanter of the femur and a suture is passed through the ruptured tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone. After the surgical procedure is complete, the incisions will be closed
with sutures or surgical tape.
PT Protocol
The intent of this protocol is to provide guidelines for your patient’s therapy progression. It is not intended to serve as a recipe for treatment. We request that the PT/PTA/ATC should use appropriate clinical decision making skills when progressing a patient. The exercises listed are not all inclusive, you can modify exercises as long as you maintain the appropriate precautions. Please obtain documentation of the exact procedure that was performed from our office. Please contact y o u r s u r g e o n if there are any questions about the protocol or your patient’s progression Please keep in mind common problems that may arise following
hip arthroscopy: Hip flexor tendonitis, adductor tendonitis, sciatica/ piriformis syndrome, ilial upslips and rotations, LB pain from QL hypertonicity and segmental vertebral rotational lesions. If you
encounter any of these problems, please evaluate, assess and treat as you feel appropriate maintaining your surgeon's precautions and guidelines at all times. Gradual progression is essential to avoid flare-ups.
If a flare-up occurs, back off with therapeutic exercises until it subsides.
Please reference the exercise progression sheet for timelines and use the following precautions during your treatments. Thank you for progressing all patients appropriately and please fax all progress notes to Greater Michigan Orthopedics office or hand deliver the the patient. Successful treatment requires a team approach. Please contact G r e a t e r M i c h i g a n O r t h o p e d i c s at any time with your input on how to improve the therapy protocol.
Initial Pre-operative Assessment
-Assess bilateral hips
-A/PROM
-Gait
-Strength
-Review surgical precautions
-Have patient practice putting brace on/off, practice PWB gait with crutches
General Guidelines/Precautions following surgery
-Weight bearing: 2 crutches, 20 pounds weight bearing for 6 weeks
-ROM: NO Active hip abduction and IR and NO Passive hip ER and adduction for 6 weeks
-Do not push through pain or pinching, gentle stretching will gain more ROM.
-Manage scarring around portal sites
-General precautions: Hip flexor tendonitis, Trochanteric bursitis, synovitis, scar tissue around portals
Day 1
-Therapy should begin post-op day 1-3
-Perform dressing change POD #3
-Examine incisions
-Teach proper brace placement
-Teach proper dressing, bathing, etc..
-Teach proper use of crutches (20 pound weight bear)
-Begin PROM
Weeks 0-4
-upright bike (no resistance) for 30 minutes to 2 hours/day
-ROM: NO active hip abduction or IR. NO passive hip adduction, ER, or IR
- PROM: Hip flexion to 90 for 3 weeks, gradually increasing after 3 weeks
-PROM hip abduction as tolerated.
-PROM Hip extension: 0 for weeks 0-3, gradually progress after week 3
-Upright bike NO RESISTANCE (must be painfree, begin 1⁄2 circles, progress to full circles)
-Joint mobilization: Grade I oscillations for pain management
-Soft tissue Mobilization:
-Gentle hip flexor
-Gait training: 20 pounds with assistive device
-Strength:
-Hip isometrics (Begin at 2 weeks): extension, adduction
-(Begin at 4 weeks): sub max pain free hip flexion
-Quad sets, Hamstring sets, Lower abdominal activation
-Modalities for pain control, swelling
Weeks 4-6
-Continue with previous exercise
-Gait training: 20 pounds weight bearing until 6 weeks and then wean to 100%
-ROM: NO active hip abduction or IR. NO passive hip adduction or ER
-Begin PROM IR (gentle, no pain)
-Begin gentle AROM of hip flexion (avoid hip flexor tendonitis)
-Joint mobilization: Gr I-II distraction, lateral distraction
-Soft tissue massage
-iliopsoas, TFL, ITB, piriformis, QL, lumbar paraspinals, hip adductors
- Strength
-Progress isometric resistance
-Quad and hamstring isotonic exercise
-Quadruped rocking
-Stretching
-Manual hip flexor stretching (gentle, no pain)
-Modified Thomas position, or pillows under buttock
-Modalities for pain control, swelling
Weeks 6-8
-Continue with previous exercise
-Gait training: wean off crutches WBAT
-ROM: Passive hip IR, Active assistive hip ER, Active assistive hip abduction, adduction
-AROM: hip flexion, extension
-Joint mobilization: Perform as needed to gain appropriate ROM
-Soft tissue massage
-iliopsoas, TFL, ITB, piriformis, QL, lumbar paraspinals, hip adductors, gluteus medius
-Strength
-Progress core strengthening
-Straight leg raise, prone hip extension, supine bridge
-Hip IR/ER using stool under knee (make sure to hold onto object for support).
-Upright bike with resistance
-Stretching
-Manual and self hip flexor stretching
-Modalities for pain control, swelling
Weeks 8-10
-Continue with previous exercise
-ROM: progress A/PROM all directions
-Joint Mobilization: As needed
-Soft tissue massage: As needed
-Strength
-Hip abduction: Isometrics to isotonics
-Progress LE and core strength and endurance as able
-Begin proprioception/balance activity (2 legs to 1 leg, stable to unstable)
-Leg press, side stepping, beginning closed chain strength, wobble board balance/taps, Single leg stance
-Stretching
-Manual and self hip flexor stretching
-Begin Elliptical training
Weeks 10-12
-Continue with previous exercise
-Gait: Normalize without AD
-ROM: Progressive hip A/PROM
-Joint Mobilization: As needed
-Soft tissue massage: As needed
-Strength: Progressive LE and core strengthening
-Hip PRES and hip machine
-Unilateral leg press
-Hip hiking
-Eccentric step downs
-Side stepping (no resistance-theraband at week 12)
-Progress balance and proprioception
-Stretching
-Manual and self: Hip flexor, hip adductors, glute, piriformis, TFL, ITB
Weeks 12-16 (Advanced Rehabilitation)
Criteria for progression to this level
-Full ROM
-Painfree, normal gait pattern
-Hip flexor strength 4/5 or better
-Hip abd, add, ext and IR/ER strength of 4+/5 or better
-Strength
-Progress core, hip, LE strength and endurance
-Lunges (multi angle)
-Plyometric progression (Must have good control with all exercises first) -
Forward/Backward running program (Must have good control with all exercises first)
-Agility drills (Must have good control with all exercises first)
-Stretching
-Progress self and manual stretches
PRECAUTIONS
-No contact activities
-No forced (aggressive) stretching
What is Hip Arthroscopy?
Hip arthroscopy is a minimally invasive surgery. Usually 2–3 small poke hole incisions (about 1 cm) are made on the side of your hip. Special instruments and a camera are used to look inside your hip and perform the operation.
What can I do until surgery?
Most people can do activities as tolerated by pain. We do not routinely prescribe pain medicine pre-operatively.
ANATOMY
What is the hip joint?
The hip joint is a ball and socket joint made up of two bones. The ball is the head of the femur (part of your thigh bone) and the socket is the acetabulum (part of your pelvis).
The hip joint is lined by special smooth articular cartilage which provides a smooth lubricated surface for your hip joint to move freely without pain or grating.
Around the rim of your acetabulum (the socket) is a special type of cartilage called the labrum. It acts to deepen the socket, providing more stability to your hip.
What is femoroacetabular impingement?
Femoroacetabular impingement is a condition where the bones of your hip joint are not shaped properly. There are two types of impingement:
- CAM impingement: Occurs when the ball (femoral head) is not perfectly round, often described as having a bone spur or bump.
- Pincer impingement: Occurs when the socket (acetabulum) is too deep, directed the wrong way, or has excess bone around the rim.
As you move in certain directions, the bones grind on each other abnormally. This can lead to tearing of the labrum and pain. It may also contribute to osteoarthritis.
How common is femoroacetabular impingement?
It is estimated that at least 1 in 4 people may have this condition. However, not everyone with this condition develops hip pain or arthritis.
SURGERY
Do I actually need surgery?
Hip arthroscopy should be considered after failing at least 3–6 months of conservative management. This may include:
- Physical therapy
- Activity modification
- Intra-articular injections
- Anti-inflammatory medications
- Tylenol
Surgery is typically used as a last resort.
If I don’t have surgery, can I play sports again?
Conservative care is always an option. If rest and therapy reduce the pain, you may return to activity. However, if a labral tear exists, activity may eventually cause pain again.
Damage may worsen with continued high-impact activities.
Will surgery prevent further damage?
Surgery reshapes the ball and acetabulum and repairs the labrum. While it may slow joint damage, it cannot repair cartilage damage that has already occurred. Recurrent labral tears are uncommon but possible.
Will surgery help the pain?
Surgery can correct mechanical problems in the hip joint. However, it does not guarantee complete pain relief.
What kind of anesthesia is used?
General anesthesia is used. Sometimes a nerve block is also provided to reduce
post-operative pain.
How is the surgery performed?
After anesthesia, the foot is placed in a padded boot. A traction device pulls the leg so the hip joint opens slightly. Using X-ray guidance, surgical instruments are inserted through small incisions.
Because of traction, temporary muscle spasms or numbness in the groin or feet may occur after surgery.
How long is the surgery?
Most procedures take approximately 2 hours.
How long will I stay in the hospital?
Hip arthroscopy is usually a same-day surgery. Most patients go home the same day if pain is manageable.
Potential Risks and Complications
Although complications are rare, possible risks include:
- Risks associated with general anesthesia
- Infection (approximately 1 in 5000 cases)
- Nerve numbness caused by traction during surgery
- Blood clots or deep vein thrombosis
- Possible continued pain or limited activity
- Future arthritis or need for additional surgery
Extremely rare complications include fracture, avascular necrosis, or impotence.
Can surgery make me worse?
Although possible, worsening symptoms after surgery are very uncommon.
POST-OPERATION
What happens after surgery?
You will be placed in a brace and moved to the recovery room. Once anesthesia wears off and pain is controlled, you can return home.
How painful is the surgery?
Many patients report less pain than expected, although discomfort is still possible.
Pain medications are provided to help manage symptoms.
What should I expect in the first few days?
During the first 2–3 days you should limit activity. You can use crutches for short walks to perform daily tasks like using the restroom.
Pain medication
Avoid anti-inflammatory medications (Ibuprofen, Naproxen, Aspirin) for at least
5 days before surgery. Narcotic pain medication is prescribed on the day of surgery.
As pain improves, you can switch to Tylenol.
Swelling and bruising
Swelling around the groin, thigh, and buttocks is common and may extend toward the knee. Bruising may also occur but typically resolves within a few days.
How long will I need crutches?
Most patients use crutches for 2–4 weeks. Your foot can touch the floor while walking, but full weight should not be placed on the leg.
Stitches
Most patients receive dissolvable sutures. If stitches must be removed, it usually
occurs around 2 weeks after surgery.
Returning to school or work
Students typically miss about 1 week. Desk jobs may allow return in a few weeks, while physical jobs may require longer recovery.
Driving
You must be off pain medication and crutches before driving.
- Left hip surgery (automatic car): about 2–3 weeks
- Right hip surgery: about 3–6 weeks
Physical therapy
Physical therapy usually begins after the first post-operative visit with your surgeon.
Recovery timeline
- Walking: immediately after surgery
- Pain-free walking: 2–6 weeks
- Running: 8–12 weeks
- Competitive sports: 4–6 months
- Full recovery: up to 1 year
Daily activity tips
- Sleep on your back or on the non-operative side with a pillow between your legs.
- Keep frequently used items easy to reach.
- Use a raised toilet seat if needed.
- Sit with hips less bent by leaning back.
- Adjust car seat to reduce hip bending.
- Avoid bending frequently during the first few weeks.
- Ask for help with daily activities like dressing and showering.
Follow-up visits
Post-operative appointments typically occur at:
- 2 weeks
- 6 weeks
- 3 months
- 6 months
- 1 year
Additional X-rays or MRIs may be required during follow-up visits.
Always contact your surgeon if you have questions or concerns.
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