Hip Arthroscopy Vignette
Patient Vignette – Hip Arthroscopy
D.P. is a 17-year-old male. He is a very active person, and a gifted basketball player. As he prepared for his freshman season, D.P. began to notice increasing pain in his hip, which he localized primarily to the groin, with occasional pain in the lateral hip (along the outside of the thigh). In addition, he noticed his motion, particularly in flexion, was decreasing. Activities such as box jumps produced a painful popping in the hip. With time, he found that he did not tolerate playing basketball for more than two hours because of the discomfort. D.P. could not recall any specific injury that started the pain; rather it just gradually worsened over time.
Clinic Visit #1
D.P. had new X-rays before he was seen by the provider. Even though he had some X-rays done before he came to clinic, more views were ordered to capture all the pertinent information needed for his visit. When the provider entered the room, they started by reviewing the history related to the hip pain. The provider then did a series of exams, including a careful evaluation of both hips, and several maneuvers to test for discomfort to the touch, range of motion (D.P. had significantly deceased motion turning his leg in with his hip flexed, also causing pain), and strength.
Hip Scope Pre Xray Frog
showed a prominence and flattening of the area between the ball and the neck of the femur, referred to as a CAM lesion (red arrow) and calcification in the labrum (green arrow).
Clinic Visit #2
D.P. had an MRI scan, and reviewed this with Dr. Hansen at his second clinic visit. The MRI (pictured)
MRI Labrum Tear Coronal 2 Right Arrows
showed the same evidence of a CAM lesion (red arrow), as well as irregularity of the labrum, the cartilage structure that surrounds the socket like a washer or gasket (green arrow).
Generally, an intra-articular injection and a course of formal physical therapy are recommended, but because of the physical limitation and level of pain, surgery was discussed without the additional attempt at non-surgical management.
Pre-Operative Clinic Visit
D.P. followed up one more time in clinic to ask questions about the surgery, and purchase the necessary equipment for after the surgery. Time was taken to discuss the medications (there are a lot!) and equipment (it felt overwhelming at first). His mom was very supportive, and also asked questions.
For 2 days prior to surgery D.P. used a special soap while showering that decreases the amount of bacteria in the skin. He received a call on the afternoon prior to his surgery with final arrangements and surgery time. D.P. was at the hospital 2 hours before her surgery time to check in to the hospital, start an IV, and sign the requisite paperwork. The surgeon signed his leg and D.P. was wheeled off to the operating suite.
Surgery included hip arthroscopy, osteoplasty (removal of the CAM lesion), and repair of the damaged labrum.
Please see more information about details of the surgery itself here, and a surgical video here. (coming soon) Pictured below is an example of a hip scope setup and an arthroscopic picture of a repaired labrum.
Hip Scope Repaired Labrum
D.P. was discharged home after less than 2 hours in the recovery room.
After the Surgery
Things happened quickly after D.P. was discharged home. He started therapy within just a few days. He was given exercises to do at home. D.P. recalls taking the pain medication for less than 2 weeks on a regular basis, but would occasionally take a pill prior to therapy. There was a love-hate relationship with the crutches and brace, but he still used them faithfully for the first 4 weeks. He also used a continuous passive motion machine (that gently moves the leg and hip for 6 hours a day) for 3 weeks after surgery. (Occasionally the timing varies depending on the exact procedure that is performed.)
Post-Operative Clinic Visits
D.P. reported back to the surgeon about 2 weeks postop to have his sutures removed. By that time he could already feel a difference in his level of pain and range of motion! New X-rays were taken at 2 weeks, which showed the change in the shape of the bone that was removed (pictured).
Hip scope Postop Xray Frog
Note the absence of the ossicle adjacent to the socket (green arrow) and the offset on the femoral neck (red arrow).
6 weeks after the procedure he weaned use of the crutches. He worked diligently in physical therapy for approximately 3 ½ months, and faithfully performed the home exercises he was taught. D.P. progressed quickly, and was able to return to full sport at approximately 4 months after his surgery.
How Is He Doing Now?
At the time of this vignette, the patient reports he is very happy with his surgical outcome. In the interim he has had the same surgery done on the left hip. D.P. reports that he has excellent range of motion, and that his long-standing hip pain and discomfort with range of motion has resolved. D.P. was able to play for his high school basketball team, and is preparing for his senior year.