Hip arthroscopy is a surgical repair or debridement (cleanup) of the hip using arthroscopic techniques and small incisions. The following are post-operative instructions for patients who have undergone arthroscopic surgery to their hip.The procedure is performed on an outpatient basis, although you may advised to be admitted overnight and discharged the next day.
The incision will be 2 or 3 small incisions sutured with nonabsorbable suture and covered with a dressing. Schedule an office appointment for about 10-14 days from your surgery so the wound can be checked. Usually, the nurses will send you home with extra dressings. You may change the dressing every 3 days until the wound is healing well about 5-7 days. (Remove dressings carefully to avoid skin abrasions). By 5-7 days after surgery if the wound is dry without drainage you may get the incision wet. If the wounds are dry and sealed you may shower and apply bandages to the wounds. If there is any drainage, apply sterile gauze, keep the wound dry and notify our office. Any wound drainage should be reported to our office. Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the thigh/knee area is not uncommon. This may even extend down the leg to the shin area and will resolve in over 3-4 weeks.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally, we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Again, swelling around the thigh and down the leg to the foot and ankle region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling. Wear the TED stockings (white) for at least 2-4 weeks after surgery. For about 4-6 weeks when you go to bed, elevate your knee with a pillow. Also, initially after going home you can lie flat on your back with your leg above the level of your heart (on 2 pillows) for 1/2 hour to reduce swelling.
An ice pack will be applied after surgery. The ice should be replaced every 2-3 hours for the first couple days. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.) After the first few days apply refreshed ice pack on the hip, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2 weeks after surgery. If you feel the swelling is excessive you should call the office.
Upon discharge from the hospital, you will be walking with the assistance of a walker or crutches. Generally walking and bending the knee is good, pain or discomfort will limit your activity. You may discontinue using the walker or crutches when you feel comfortable and walk without a limp, on the average within 2-3 weeks (may use a cane or single crutch if desired). You may go up and down stairs as needed and physical therapy will help with some tricks until flexibility allows normal stairs.
In order to reduce stiffness and obtain maximum function of your hip, it is important to maintain a good balance of rest and exercise. Listen to your body; too much activity will produce increased swelling and/or pain; too little activity could prolong your recovery and/or limit your hip mobility. The physical therapist should provide you with leg and hip exercises. To promote circulation, remember to do your ankle/foot stretching and pumping exercises regularly.
Avoid crossing your legs if you are lying flat on a bed or floor for 3 months after surgery.
Usually, we will start full on therapy at 4 weeks after surgery. Although formal physical therapy is not 100% essential to obtain a good result with arthroscopic hip surgery, we believe it is definitely helpful in achieving the quickest and smoothest course to full recovery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately.
Isometric Quadriceps/gluteal Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down. Then repeat this with the gluteal muscles (buttock). Laying down you can lift your head and hold to get a good core or abdominal isometric muscle work.
Ankle pumps/toe curls: Pump your ankle up and down frequently throughout the day to keep blood flowing and prevent blood clots. Also, curling the toes tightly activates the foot muscles which act as a pump for blood.
These are averages, remember that each case is individualized, depending on your general health, age, and attitude. For 3-4 weeks after surgery, your activity level is usually limited, however, you will be able to walk independently and use bathroom and kitchen facilities. Within 6 weeks you will have resumed more of your normal activities. Squatting and kneeling come with time. Good surgical wound healing takes 3-4 weeks, complete tissue healing is over 6-9 months. During this initial 3-4 weeks some swelling and discomfort is normal and should be manageable with the prescribed medications. After this time the hip tissues begin to soften and become more natural.
Arthroscopic hip surgery is a fairly straight forward and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. The onset of symptoms would be approximately 5-7 days following surgery and would consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner. If we did not start this let us know. If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized. A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD