Procedures

The Hip

The Groin


Hip Arthroscopy

Hip arthroscopy is a minimally invasive procedure used for evaluating and treating a variety of hip conditions, particularly hip problems in the young, active patient.

Traction is placed on your leg to create more space within your hip joint to allow the entry of surgical instruments. Two small incisions (<1cm) are made around your hip which allow the passage of a thin telescope/camera (arthroscope) to inspect your hip joint and passage of surgical instruments which are used to shave, trim, cut, smooth or repair the affected areas.

X-Rays are used to guide the entry of the arthroscope and the surgical instruments.

Hip arthroscopy usually takes approximately 1 hour 40 minutes to perform.

If examination of your hip with the arthroscope indicates further surgical treatment, this will be performed at the time of your surgery.

The operation is normally carried out as a day procedure however you may require an overnight stay.

View the Hip Arthroscopy (Procedure) Gallery »

Indications for Hip Arthroscopy

The majority of patients who require hip arthroscopy are young and active with a history of recurrent hip or groin pain.

Common causes of hip pain are
  • Labral tears
  • Hip impingement
  • Articular cartilage injuries
  • Loose bodies
Less common causes of hip pain are
  • Tendon or ligament injuries
  • Instability of the hip joint
  • Synovial disorders
  • Infections in the hip

If you are young and active and have experienced hip pain that has not improved with conservative treatment consisting of anti-inflammatory medications and physiotherapy for greater than six-months, you may be a candidate for arthroscopic surgery.


Arthroscopic Treatment of Labral Tears

Isolated labral tears are uncommon; they usually present in combination with underlying hip impingement and are often associated with separation or detachment of the labrum. The labral tear may be repaired however it is more common to debride the tear preserving as much of the undamaged labrum as possible.


Arthroscopic Treatment of Femoral Acetabular Impingement and Labral Detachment

Labral separation or detachment is the most common pathology requiring hip arthroscopy at the Hip and Groin Clinic; the detachment is almost always associated with a pincer and a CAM deformity. Simply repairing the detachment is unlikely to be effective as the hip impingement (the cause of the detachment) will remain unchanged; acetabular recession (removal of the pincer deformity at the edge of the socket) is necessary , along with removal of the CAM deformity of the femoral head (the bump on the front of the ball).

The labrum is probed and the region of detachment is noted; the detachment is invariably associated with damage and flapping of the edge of the joint cartilage. The labrum is formally detached using a ‘banana’ shaped knife; this exposes the rim of the socket very clearly. The pincer deformity at the edge of the socket is removed using a mechanical burr. The torn and flapping cartilage at the edge of the socket is debrided back to a stable rim. The edge of the socket is prepared and multiple drill holes are performed into which suture anchors are placed; the sutures are passed around the detached labrum and tied, fixing the labrum tightly against the socket edge, recreating a more normal edge to the socket.

Any defects in the cartilage of the joint surface are unlikely to heal naturally, as such a microfracture or Subchondral drilling procedure is performed in an attempt to create vascular channels from deep inside the bone to the surface, promoting healing.

Following repair of the labrum, the traction is released and the rest of the operation is performed without. The CAM deformity on the femoral head is then removed using a mechanical burr recreating a more natural shape to the femoral head; the improvement in the impingement can be gauged by moving the hip joint and observing the free movement and relief of impingement with the arthroscope.

To view the treatment of FAI please go to Hip Arthroscopy (Procedure) Gallery.

Further information on Hip Arthroscopy

For the patient:

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For the Medical or Sports Practitioner


Total Hip Replacement

Total hip replacement remains the gold standard of treatment for severe degenerative osteoarthritis of the hip in patients over the age of 55 years.

Modern total hip replacements have been successfully implanted into patients for over forty years; hip replacement has been described as one of the most successful, life changing operations ever performed.

The operation removes the femoral head and neck replacing them with a femoral stem with is placed into the upper femur (thigh bone) and a femoral head replacement (ball); the acetabular cartilage is removed using mechanical reamers and a new acetabular component (cup) is inserted into the socket. The materials used for the femoral head and acetabular cup may vary; traditionally a metal head with a plastic cup has now largely been replaced with either ceramic or metal bearing surfaces (this allows larger diameter components to be used increasing the stability of the joint and reducing the wear rates).

The components are either held in place using cement (as a grout) or with biologic fixation (no cement but relying on the host bone to grow onto the components over time, stabilising the components).

Click here for  full information on total hip replacement and post operative rehabilitation. [pdf]


The Groin

Please refer to the Rehabilitation page for all post-operative rehabilitation programmes.

Groin Repair

Groin repair is required for athletes who have failed a programme of rehabilitation and groin strengthening. The procedure is performed as a daycase or short overnight stay at the clinic.

A small 4 cm incision adjacent to the pubic tubercle is used to gain access to the external oblique aponeurosis and external inguinal ring; at this stage it is possible to observe deficiencies in the external oblique and dilation of the ring. The aponeurosis is reflected and the spermatic cord and vessels are isolated and carefully retracted. The posterior wall of the inguinal canal is examined and weakness in the tranversalis fascia identified; the disruption of the conjoined tendon from the pubic tubercle and its wide displacement from the inguinal ligament is a recognised feature.

The structures of the inguinal canal are repaired in four layers, recreating a robust and strengthened groin; the external ring is refashioned.

Post operative discomfort is well controlled with an ilioinguinal and iliohypogastric nerve block along with infiltration of local anaesthetic. Mobilisation begins the evening of surgery and the physiotherapist begins working with the patient through the rehabilitation programme.

Review appointments are planned every two weeks and a return to sport is expected around 6 – 8 weeks from surgery.


Adductor De-tensioning

This procedure is performed for athletes with chronic adductor strain who have failed to recover following an adductor rehabilitation programme provided under the supervision of the clinic. The procedure is usually performed as a daycase although a short overnight stay may be required.

A small 3 cm incision overlying the adductor muscle group is used to gain access to the adductor muscles. The muscles and their tendons are examined for pathology; the muscles are de-tensioned individually; an adductor tenotomy is never performed.

A repair is then employed before tissues are closed in layers. Local anaesthetic infiltration is used to ease post operative discomfort.

Mobilisation is encouraged the evening of surgery and the physiotherapist will advise on the rehabilitation programme.

Review appointments are planned at two and four weeks post operation. A return to sport is expected at 6 weeks post procedure.


Adductor Tendon Repair

This procedure is required for athletes who have suffered a partial or full tendon rupture or a large mid substance tear.

A small 3-4 cm incision overlying the adductor muscle group is used to gain access to the adductor muscles. The muscles and their tendons are examined for pathology; a mid substance tear is identified and repaired; the involved muscle is then de-tensioned as above to encourage healing; a tendon rupture from its origin is identified, the footprint on the pubis is prepared and drilled, suture anchors are used to re-approximate the tendon to the origin; the involved muscle may also require de-tensioning.

The tissues are closed in layers. Local anaesthetic infiltration is used to ease post operative discomfort.

Early mobilisation is encouraged and the physiotherapist will provide a personal rehabilitation programme depending on pathology and type of repair employed.

Review appointments are organised at two, four, six and twelve weeks post operation. A return to sport can be expected around 12 weeks post operation.


Pubic Cleft Injection

This procedure is performed for athletes with adductor discomfort which has demonstrated moderate improvement with adductor rehabilitation under the clinic’s supervision; the injection is performed under local anaesthetic and as a ‘side room case’. It takes a few minutes to complete; the injection of local anaesthetic and corticosteroid is placed into the pubic cleft under image intensifier (mobile x-ray). Twenty minutes following injection an examination will be performed to ensure the injection has been successful. The physiotherapist will see and advise on further post procedure rehabilitation.


Fascia Lata Release

This procedure is performed for patients who have resistant extra-articular Snapping Hip (Coxa Saltans) and have failed to improve following rehabilitation under the supervision of the clinic.

The procedure is performed as a daycase and may be performed with the patient awake under local anaesthetic block or under general anaesthetic.

A 5 cm incision distal to the prominence of the greater trochanter is utilised to gain access to the fascia lata; a cruciate type incision is used to release the tight bands of the fascia lata overlying and crossing the trochanter.

The tissues are closed in layers. Local anaesthetic infiltration is used to relieve post operation discomfort.

Early mobilisation is encouraged and the physiotherapist provides advice on rehabilitation.

Wound inspection is performed at 10 days post operation and one review appointment is usually required at 4-6 weeks post operation.

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