Questions to ask your Surgeon before Hip Arthroscopy
The decision to undergo hip arthroscopy surgery is not an easy one to make, and it should consider several questions. Some may include – How do I maximize my long-term hip health? How do I get the best rehab for my hip? What are the pros and cons of a surgical vs. conservative approach? These are big questions, and I’ll be working to answer those in future posts. However today, I want to give you a concrete list of questions to ask your surgeon before considering hip arthroscopy. A surgeon should be happy and open to answering these questions in order to assure your best care, and to include you as an equal partner in decision-making for your healthcare.
How many procedures do you do like this per year?
In a study Dr. Derek Ochiai performed in 2010, he reports that “looking at both novice and experienced surgeons, it took a minimum of 50 hip arthroscopies per year before a surgeon even planned FAI surgery in a similar way to a surgeon who performs more than 200 hip arthroscopies per year.” Another example is Dr. Allston Stubbs, a hip arthroscopy specialist in North Carolina, who performs well over the national average of 200 scopes per year. You want to seek out a surgeon who specializes in hip arthroscopy and that has a minimum number of surgeries that rivals the national average in order to maximize your chances for a best outcome.
What percentage of cases involve FAI osteoplasty (reshaping the bone of the socket side (acetabulum), the ball side (femoral neck), or both? And, also ask what percentage of cases involve suture anchor labral repair.
In the case of surgeon Dr. Ochiai, he states that, “in younger patients the percentage of cases where he performs FAI osteoplasty and labral repair for a symptomatic labral tear is greater than 95%. It is extremely rare for me to perform a labral debridement alone.” For this reason, I again highly recommend seeking out a surgeon who exclusively specializes in and performs hip arthroscopy.
What is your rate of complications during surgeries that you have done, and what type of complications are injuries are they?
Typically, nerve injury to the pudendal nerve or lateral femoral cutaneous nerve, due to traction forces, duration of traction during surgery, or entrapment, are the most common risks. However, that risk typically remains low, reported at about 20% or less. Additionally, the injury is usually transient, spontaneously resolving after surgery without any lasting consequences. Other complications, like dislocation, fractures, or secondary labral injury, are possible but low.
What type of drugs and what dose to you prescribe after surgery? Why?
There can be a veritable laundry list of medications that are necessary after surgery, with some surgeons prescribing or offering more than others. Most of these are to minimize risk after surgery, such as with nausea, inflammation, bony regrowth, blood clots, constipation, muscle cramping, and/or pain. Pain medications typically are short-lived and do not need to be taken long after surgery, especially since there is a risk of dependency. The other medications, some over-the-counter like anti-inflammatories or aspirin, should be judiciously prescribed by, and discussed with, your surgeon.
Nausea and muscle cramping are also uncomfortable side effects from surgery and anesthesia. However, pharmaceuticals for them can also carry risk, like remarkable constipation and digestive issues. There may be safer alternatives to these drugs, like addressing proper hydration, physical therapy, and nutrition, which could make it possible to avoid these medications and their complicating side effects. Stronger prescription anti-inflammatories and anti-clotting medications may be very necessary due to the type of surgery done; therefore, it is important to adhere to the plan of care concerning these drugs since they can affect your surgical outcome and lower your risk of dangerous blood clots.
What is your average recovery time?
Recovery time can widely vary, however, this is not well addressed in the literature to date. For example, a 25 year old professional athlete will have a vastly different rehab schedule and recovery time that a 42 year old postpartum mother who suffered the injury as a result of pregnancy. See the huge difference? Typical post-surgical protocols last only 4 months; however, there has not been a single patient I have seen that required a mere 16 weeks of physical therapy. All the patients I have seen or discussed rehab with, including my own rehab, took between 12-18 months to fully return to activity and feel like yourself again.
Do you prescribe or recommend pre-hab (physical therapy before surgery)? Why or why not?
As an orthopaedic physical therapist specializing in the hip, I 100% believe that pre-hab is not only incredibly helpful, but absolutely necessary. It can cut down on recovery time after surgery, improve safety and reduce re-injury risk not only immediately after surgery but in the long-term, and reduce out-of-pocket expense for the patient. I would highly recommend seeking out a surgeon who also believes in conservative therapy and its value.
How soon does PT start post-surgically?
PT should begin before leaving the hospital, for things like transfers education, assistive device and stair training, and general intervention that will reduce nausea, constipation, and pain. After getting home, PT can begin right away – of which over 90% will be passive therapies prescribed to improve healing, reduce pain, and improve your comfort and ability to sleep, move through the house, and complete activities of daily living. If you do not have someone to drive you to PT, you may be eligible for home health PT services. When starting outpatient rehab, you will begin with more frequent visits, which may include your family members – to teach them how to help you get in/out of bed or a chair or car (especially if you are on crutches and nonweightbearing or foot-flat weightbearing(no more than 20# on surgical leg, typically) for 4-8 weeks after surgery), and to also help you passively range/move your hip therapeutically. Visits may be as often as three times a week for the first several weeks, then may taper down to 1-2 for several months, depending on type of surgery and progress.
How many of your patients return to full sport and activity post-surgically? When? How do you track their progress or follow up with them?
Post-op rehab typically required a minimum of 4 months of intensive therapy, followed by continued home-based work and possible adjunct PT for another 6-8 months. I can say with confidence that especially in more complicated cases, such as pelvic or women’s health issues that may have accompanied the hip injury, rehab can be expected to take longer, up to a year or more, before feeling “your normal self” again.
Returning to prior activity is a common question I field – and the answer to that depends on many variables such as: 1) extent of labrum injury (the more razed the labrum or surrounding bone, the less likely the repair can be done neatly and with a good long-term outcome), 2) the age of the patient, as well as gender. Younger patients don’t always necessarily do better, but the physiological age of a person (i.e. how well they take care of themselves, respond to stress, nutritional habits, sleep quality) matters most. Gender can complicate issues since pregnancy is a risk factor for labral tears, and the accompanying debility and physical strain that is exacted by pregnancy can complicate recovery. Monthly cycle patterns, I have noticed in hundreds of cases, also complicate recovery and return to activity. 3) The health of the person prior to surgery. Variables like nutrition, sleep, and stress response have an enormous impact on quality of life, as well as outcome of surgery. The gut microbiome also plays an enormous role in recovery as well – so nutrition, sleep, and stress response – as well as a well-colonized gut with “happy” probiotic bacteria, should be addressed pre-surgically. 4) The physical status of the person, as well as her/his mental outlook and health on life. 4) Healthcare professionals who follow best evidene practice. Surgeons and therapists who use standardized outcome measures or inventories to track progress and ability to return to sport, are following best evidence practice. For example, there are currently no therapy inventories that are exclusively validated for the hip – but tests like the Vail Sport Test can be adapted for use with the hip to help a therapist determine when/if a person is ready to return to regular activity or sport. It should also be noted that those inventories should not be the ONLY measure used to determine discharge from rehab. Functional tests and measures should also be used. These are certainly not the only variables, but they are perhaps the most important ones when it comes to enjoying a best-case scenario outcome.
What is your follow-up routine after surgery?
Unless you are a healthcare provider who can remove sutures, you will return to your surgeon within a week to 14 days to have your sutures removed. After which there are typically 1-2 return visits (or more, if there are complications or the surgery (such as osteotomy or osteoplasty) was more complex, to monitor progress and also make recommendations or suggestions for weightbearing restrictions or precautions. Your physical therapist will have vital information to share with the orthopaedic surgeon, so you want to make sure your PT sends the surgeon progress notes, and that the surgeon actually reads the PT’s notes. The BEST hip arthroscopy outcomes require a team approach – and that means having the surgeon and therapist maintain close contact and discussion concerning your care. This should be a minimum standard, however, in many cases this does not happen. Ask your surgeon and PT about communication, and also ask your surgeon about how many visits are typical for surgical follow-up. You deserve the best care possible, which includes good continuity of care and communication between your healthcare providers.
Good luck and best wishes on your journey for a successful surgery and return to the life you want and deserve. And if I can give you a parting tip – Remember, stay positive, because your body hears (and responds to) everything your mind says.
- Check out Top Five “Must Haves” for Hip Labral Surgery (plus two bonus tips!)
- Common Pre-Operative Questions – Hip Labrum Surgery
- How Long Does Recovery Take after Hip Labrum Surgery
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