Dr. Carreira has performed approximately 2,000 hip arthroscopies for a variety of diagnoses. The techniques of hip arthroscopy have developed especially over the past 10 years, and these developments have led to significant improvements in patient outcomes.
Length of Hospital Stay: Outpatient or 23 hour admission
Length of Procedure: Approximately 2 hours
Anesthesia: General with a regional lumbar plexus block
What is Hip Arthroscopy?
Hip arthroscopy is performed through small approximately one centimeter incisions (typically two or three) using a camera to visualize the inside of the joint. Instruments are inserted through these small incisions to perform the work.
The benefits of hip arthroscopy over open surgery include earlier rehabilitation, an accelerated rehabilitation course, less pain and blood loss, and a lower rate of infection.
In the past, diagnosing hip injuries was difficult and the treatment options were limited. Now, advanced diagnostic imaging and a better understanding of pathologies such as labral tears and femoroacetabular impingement have led to more accurate diagnoses, some of which can be treated through an arthroscopic approach.
A number of different pathologies may be treated with hip arthroscopy, including snapping hip, trochanteric bursitis, labral tears, focal chondral injuries, and femoroacetabular impingement. Hip arthroscropy can offer improvements for a number of hip problems.
The typical patient who may benefit from hip arthroscopy is suffering from hip pain and does not have a diagnosis of hip arthritis. Arthritis is defined as generalized or diffuse articular cartilage injury of a joint. Hip pain typically occurs in the front and/or the side of the joint, and may also be present in the buttock. Rarely hip joint pain occurs only in the buttock. Patients may experience pain with movement of the hip joint, including flexion, such as when tying shoes or getting into a car, or at rest, such as when sitting or trying to sleep. The majority of patients, as noted in our MASH study group of over 2500 patients, have a gradual onset of pain without a history of trauma or injury. Patients generally have “normal” x-rays that do not show any signs of arthritis. On close review of these x-rays however, forms of femoroacetabular impingement (FAI) may exist. MRI typically is performed to detect labral tears, which are a common cause of chronic pain in the hip joint. Patients typically experience increased pain with increased activity, either during the activity itself or in the day or two following the activity.
Videos of Hip Arthroscopy
To help his patients learn more about potential surgical options, Dr. Carreira has made a number of videos to give his patients some insight into hip arthroscopy.
In the video below, Dr. Carreira offers some insight into the benefits of hip arthroscopy, especially in younger patients.
In this next series of videos, Dr. Carreira describes a number of surgical treatments involving hip arthroscopy.
All Arthroscropic Allograft Labral Reconstruction of the Hip
In March 2014, Dr. Carreira delivered a presentation to the American Academy of Orthopedic Surgeons focused on his unique approach for using a shuttle technique using allograft fascia lata in cases where acetabular labrum tears are irreparable.
These videos are also available on Dr. Carreira’s YouTube channel.
Risks of Hip Arthroscopy
As with any surgery, there are risks that must be taken into account. Infection is decreased by careful attention to sterile technique, IV antibiotics on the day of surgery, and careful handling of the incisions following surgery.
Deep vein thrombosis (DVT or blood clot) is decreased by instituting early motion (CPM), mechanical means (foot pumps and Ted Hose for 4 weeks), and rarely blood thinners.
Pain is kept under good control throughout the postoperative period by taking medication, ice, rest, compression, and therapy. Depending on the extent of injury noted at the time of surgery, long term pain relief can be best predicted, with most patients returning to a pain free and active lifestyle.
With hip arthroscopy, there is a small chance of numbness in the genitalia region for a brief time postoperatively. Also, injury to the lateral femoral cutaneous nerve may result in numbness of the upper outer portion of the thigh on the operative leg after surgery. The nerve is close to the surgical area, and the numbness resolves over time. Complications related to anesthesia are very rare but can also occur, as with any surgery.
Our rehabilitation protocol requires strict compliance for optimal results. Weight-bearing (approximately 20 pounds of foot flat) is recommended for 2 days to 8 weeks after surgery. The length of protected weight bearing will be determined at the time of surgery. You will have the aid of crutches. Supervised physical therapy will begin within 3 days surgery. It is important that you follow this program closely. During this time you will be taught a home exercise program.
Dr. Carreira has produced and posted a number of videos about hip arthroscopy recovery.
The above video shows a 61-year old physician and marathon runner who is two months postoperative, running a 8:30 minute/mile pace at 85% weight-bearing on an anti-gravity treadmill. The marathon runner is recovering from arthroscopic hip surgery, undergoing physical therapy with with Bryan Graham at Oceanside Physical Therapy.
Arthritis and Arthroscopy
This video demonstrates a 76-year-old man who is pain free just three weeks after hip arthroscopy.
This patient had no arthritis identified before surgery or at the time of surgery, which is unusual for a patient with hip pain at this age.
However, this case points out the fact that each patient individually needs to be assessed for arthritis regardless of age. Arthritis does occur more often as we age, but there are patients in their 30’s and 40’s who have severe arthritis and patients in their 60’s who have little to no arthritis.
The best imaging study to assess arthritis is a plain x-ray. If any joint space narrowing is noted, the arthritis oftentimes is too advanced for a hip arthroscopy procedure and a joint replacement or resurfacing is preferable.
Sleeping in a prone position (on your belly) is recommended one to two hours per 24 hours to stretch out the hip flexors.
Driving and flight information
Legally, you are not allowed to operate heavy machinery (this includes cars!) while on narcotics. Make sure that you try driving in a wide open parking lot prior to driving on the road to make sure that you are comfortable and not compromised in your ability to drive.
With regards to flying or longer traveling by car, precautions should be followed closely to prevent blood clots. During the time that you are not fully weight bearing, we recommend that you perform ankle pumps, which are repetitive motions of the feet up and down. If you are flying, we recommend getting up and using your crutches to move about approximately every hour.
CPM (Continuous Passive Motion)
A CPM machine will be supplied to you within 36 hours after surgery. In a 24 hour period and while in bed, the CPM should be used ideally for four to six hours if no microfracture has been performed, and for 6- 8 hours if a microfracture has been performed.
If are in bed and not using the CPM, you will need to use the boots which prevention external rotation (turning out of the foot and leg). These boots are securely strapped to a round pad with Velcro straps. We recommend use of the CPM while sleeping at night to avoid use of the CPM machine during the day. When laying in bed and not using the CPM, the rotational prevention boots should be used to keep the toes pointed straight up to the ceiling.
Return to Work
You may return to work within one week after surgery, as long as the pain is well-controlled. However, you must take the time to go to therapy and to your office visits, and you must follow all postoperative instructions carefully while at work. Returning to heavy labor or sports will be determined by your progression through physical therapy and by the extent of damage in your hip.
When returning to full activity, preference is placed upon biking and swimming for cardiovascular exercise.
A detailed information packet regarding hip arthroscopy is provided for patients undergoing surgery. Many of the important details regarding the surgery and its recovery are reviewed to help guide patients during their recovery.
Psoas Release After Hip Replacement
Following hip replacement surgery, further hip arthroscopy may be indicated in patients who have a painful psoas tendon following hip replacement surgery. The above video details the psoas release after hip replacement, with Dr. Carreira providing the voiceover for the video.
American Association of Orthopedic Surgeons
The American Academy of Orthopedic Surgeons (AAOS) has an entire section of its website dedicated to providing detailed information about hip arthroscopy.
New Hip Arthroscopy Research Projects by Dr. Carreira and the Carreira Research Group
Dr. Carreira and the Carreira Research Group are currently conducting several clinical research studies regarding hip arthroscopy. Each study will focus on assessing and improving the current surgical standard of care. Patients that are candidates for hip arthroscopy are provided with the opportunity to contribute to the advancement of medicine. Qualifying candidates for the study may participate voluntarily by completing an informed consent process. For more information about this study, please contact Dr. Carreira.
The MASH Study Group
Co-founded by Dr. Carreira, the Multicenter Arthroscopy Study of the Hip (MASH) Study Group is a group of ellowship trained orthopaedic surgeons focused on the treatment of hip injuries and hip preservation in the athletic and pre-arthritic population.
More information about the MASH Study Group is available on its website, mashstudy.com.