What to Expect from a Hip Arthroscopy

Charles Burt:

Our understanding of hip and labral tears has grown exponentially over the last 15 to 20 years, and we have a lot of treatment options now that didn’t exist even four or five years ago.

Here at OrthoNebraska, we do some things that a lot of people don’t necessarily do to help maximize the rate of success for our patients.

We know now that in people who have labral tears where their labrum is either degeneratively torn or very small or highly contused and non-functional, that those people are often the ones who have the highest risk of not having complete symptom resolution or requiring more surgery.

To address that, what we often do with people is a three-pronged approach when we repair the labrum.

If your tissue is of good quality, good size, robust, healthy, we will repair your own tissue, and that’s always our first option.

But for a lot of people that’s just not possible, that their tissue has been too damaged, it’s too small, it’s not going to be functional.

And so if you have tissue that is still of reasonable quality but [it’s] too small and slightly damaged, we’ll do what’s called a labral augmentation where we will repair your own labrum, but we will add some donor tissue to that to reinforce that, to bulk it up, to get it to a size where it will function more appropriately.

And we know that if the labrum functions appropriately after repair, it’s less likely that you’re going to have any ongoing problems.

And we would view that as our level two. Level one: repairing the labrum. Level two is an augmentation.

The third level of treatment is what’s called labral reconstruction, and typically that’s for people who have a larger area of more extensive labral damage, people who have what’s called severe pincer impingement where your hip socket’s so deep, and in those people oftentimes the labrum just didn’t develop correctly, and so you don’t have much labrum.

But once we correct that bony impingement, the function of the labrum becomes even more important, and so in those people we actually replace the vast majority of labrum with a much larger graft.

As you can imagine, as we go up the tree, level one, two and three, the surgery becomes a little bit more involved, but we do all of that arthroscopically.

The reason we do those different things for the different problems is we know [that] to get to a similar level of success surgically — we do them for different reasons, but each of those different treatments will increase the likelihood of success for that section of patient.

Natashia Klostermann:

I’m Tasha Klostermann. I’m a physician assistant here at OrthoNebraska. I’ve been working with Dr. Burt for nearly 13 years.

Our specialty is hip arthroscopy. Surgery is done at the OrthoNebraska Hospital.

The morning of surgery you’re going to meet with our anesthesia team. They’re going to talk to you about a different type of block that we can do to help with your post-operative pain.

Surgery itself is done through about two or three little poke hole incisions on the side of your hip.

At the time of surgery we’re going to address the labral tear; we are going to address that impingement.

Surgery takes about an hour and a half to two and a half hours.

We send you to recovery then in the hip abduction brace, and then we are in the recovery room for a couple hours, and then we send you home on the crutches.

The recovery from here on out is pretty slow.

We keep you on crutches with what we call flat foot weight bearing, so putting that foot down just for balance purposes but not more than about 20% body weight on it.

Pain is not too bad. Most patients only take pain medications for a couple days. You’re taking it pretty easy because you have the crutches and you have the brace, so you’re not doing a whole lot.

Despite not having pain, we still urge you to take things very slowly. This is not a “no pain, no gain” scenario.

In recovery, when you start physical therapy, usually around that two to three week mark, your physical therapist is going to work on progressing you off the crutches. That may take a few days, that may take another couple weeks. It’s not a rush.

The key to getting off of crutches is walking without pain and without a limp. So listen to your physical therapist and follow those guidelines.

Tom Niemann:

My name is Tom Niemann. I’m an outpatient Physical Therapist here at OrthoNebraska. I’ve been here about 16 years. I’ve been working closely with Dr. Burt and Tashia.

So from my standpoint as a therapist, I’d say especially in the first weeks that we see you in the clinic, it’s probably more about what you don’t do than what you do.

You’ll still be in your brace and we’ll help you with weaning out of that.

Oftentimes what we see people struggle with is they try to advance their weight-bearing faster than their muscles are ready for.

Therapy usually starts at about two weeks post-op. You’re still on crutches, you’re still on limited weight bearing, but we start to progress you.

Initially therapy focuses largely on protected range of motion, muscle activation, and then in the weeks that follow we start having you weight bear more. We start working on and normalizing your walking pattern, gradually weaning you down from two crutches to one crutch to eventually no crutches.

All of this can be quite varied in its progression. Some people move along very quickly with this. Other people, sometimes it takes them upwards of six weeks post-op before they’re fully off crutches.

A lot of it’s based upon strength return, pain levels, and then just how well they can demonstrate a normalized walking pattern.

You know, the rehabilitation picture for somebody who is 45, they look very different than somebody who is 18. And so it kind of gets customized in that regard.

Some people don’t want to return to running and so we don’t do that. Other people want to return to high level sports, and so that rehabilitation picture is going to look a little bit more involved and be a little bit lengthier.

Our role is not only to help you with your exercise progressions but also to help you with safe progressions of activity, to guide you along the way to really reach your most optimal outcome.

Charles Burt:

As a former competitive athlete, I understand what it’s like to be hurt and how important it is to be able to feel confident that the people who are taking care of you understand what you’re going through and are committed to getting you back to the sport you love.