Hip Arthroscopy: Minimally Invasive Procedure to Manage Hip Pain

With advances in surgical instrumentation and techniques, hip arthroscopy has evolved to help patients with certain injuries or positional hip pain to return to normal activities and help prevent degenerative disease of the hip joint, primarily arthritis.

It is an outpatient procedure that allows doctors to see the hip joint without making a large incision through soft tissues. Arthroscopy is utilized to diagnose and treat hip problems.

Orthopedic surgeon and hip preservation specialist, Lionel E. Lazaro, M.D.

“Hip arthroscopy is done to restore and preserve the function of the native hip, eliminate pain source and try to avoid the suffering of progressive degenerative process (arthritis) and the need for hip replacement in the future,” said Lionel E. Lazaro, M.D., an orthopedic surgeon and hip preservation specialist with Miami Orthopedics & Sports Medicine Institute.

The remarkable recovery process starts the next day.

“Patients go home the same day and physical therapy starts the day after surgery,” said Dr. Lazaro. “Post-operative Day 1: The patient is riding a stationary bike, and then a protocol advance by phases with goals and hard stops designed to have a smooth return to painless full hip function.”

Here is more information from Dr. Lazaro on hip arthroscopy, preventing hip pain during the COVID-19 pandemic, and what you should know about getting medical help for hip pain.

How is hip arthroscopy different from traditional hip replacement?
“Hip arthroscopy is done to preserve the function of native hip and try to avoid the suffering of degenerative process (arthritis) and the need for hip replacement.”

What type of patient is eligible for hip arthroscopy?
“Patients that present with Femoroacetabular Impingement Syndrome (FAIS), with symptomatic labrum tear that failed conservative treatment. With hip impingement, there is conflict between the bone structure of the hip that can limit the range of motion and lead to progressive degenerative changes over time. FAIS includes the combination of history, physical exam and radiographic findings of symptomatic bony impingement.”

How does a patient know if this type of surgery is right for them?
“If you have positional hip pain, coupled with no radiographic signs of degenerative disease (arthritis), you may be a candidate for hip arthroscopy.”

Why is hip arthroscopy not recommended for patients with moderate or severe arthritis?
“The previous research has demonstrated that once arthritis is present, the post-operative outcomes is unpredictable and poor. Some people get a few more years before they need of replacement surgery. However, sometimes it can make the patient worse.”

How are the outcomes of this surgery?
“When the surgery is indicated well, outcomes are great. Return to play is excellent and patient are very happy. However, bad surgical indications can lead to very poor outcomes and disability.”

During this COVID-19 pandemic, people have experienced increased hip pain due to unsupervised at-home workouts and extended time sitting & working on the computer. What advice would you like to give to people suffering from hip pain?
“Definitely, pay attention at your posture during both work and/or at-home workouts. If you are having pain that doesn’t go away or keep coming back, stop doing what you are doing and go get evaluated. Pain is your body telling you that something is not right.”

What changes should they implement while working from home?
“Avoid sitting for long time, stand up desk is a good option.”

Do you have any tips for managing hip pain, such as exercises or stretches?
“You should know what is causing the pain, so you can manage correctly. There are multiple structures about the hip that can give you pain, and sometimes it’s a combination of them. Depending on the problem, the exercises regimen change. Stretches are always good, if the area is tight. However, some people with hip pain have excessive flexibility and maybe stretches may not be the best. Hamstring stretches are always good and necessary.”

When should someone with hip pain seek medical attention?
“Definitely, pain is your body telling you something is wrong. If it doesn’t go away or it keeps coming back, you should seek medical attention. If you seek medical attention, but the diagnosis can’t be established, or you are not improving with conservative treatment, patients should go and see a hip preservation specialist. Over the last 10-15 years, there have been significant advances in knowledge regarding the pathologies associated with non-arthritic hip pain.

“The earlier the correct diagnosis is made, the better the patient does after treatment. Usually, the pain is episodic and can be associated with specific position/motion. But the patient can usually push through the pain and do the activity. Having hip pain alters the mechanics of the entire body and results in compensatory injuries outside the hip joint. Some of these injuries are painful and can limit patient life. This compensatory injury then complicates the clinical picture and patients end up having treatment for the compensatory injuries — but the source of the problem is not addressed.”