Have you had keyhole hip surgery that hasn’t worked?
Revision Hip Arthroscopy
Mr. Carton regularly re-operates on patients, with ongoing pain and stiffness, following hip arthroscopy in other centres. He has an 80% success rate in alleviating these chronic symptoms.
“The main reason for patients having poor success from their original hip surgery is incomplete correction of the bony deformities in the hip.”
Correction of Residual Bony Deformity
Figure 1: 38 year old female athlete with residual ‘Pincer’ deformity on the rim of the acetabulum (socket) causing persistent stabbing pain and catching in the hip (white arrow).
Figure 2: pre and post op CAM resection
Figure 2a: 19-year old male footballer with persistent ‘CAM’ deformity following original surgery at another centre. Figure 2b CAM deformity removed
Preserving and Repairing the Labrum
Once we correct the residual bony deformity, we then repair the labrum (‘joint seal’). The labrum is a vital structure needed for stabilising the hip joint and we try to preserve and repair the labrum in every case.
Figure 3: Labral Repair
Labral Graft Reconstruction
Many centres do not repair the labrum and in some centres the labrum is partially or completely excised! In this case we reconstruct the labrum using hamstring tendon. This is known as a Labral Graft (figure 4a and 4b).
Figure 4a: Hamstring tendon being prepared to use as a labral graft
Figure 4b: Hamstring tendon graft (white arrow) in place along the rim of the acetabulum (socket) reconstructing the labrum (excised at the previous surgery).
Preserving and Repairing the Hip Capsule
The hip capsule is a very important structure – it is essentially a ‘thick coat’ tightly fitting around the hip joint and keeps the hip stable. The capsule is opened during keyhole surgery to allow movement of instruments – we repair the hip capsule in every case.
In many centres the hip capsule is partially excised and not repaired and this can result in instability of the hip joint resulting in pain, muscle tightness and further deterioration.
Figure 5a: Large defect in capsule after initial surgery at another centre (white arrow). Suture placed for repair (blue stitch)
Figure 5b: Large defect in capsule now repaired (white arrow). Suture tightened (blue stitch)
“We re-operate on a patient who had their original surgery in another centre approximately once every three weeks.”
Figure 6a: Damage to articular cartilage of the femoral head from poor resection technique (white arrow). Normal cartilage (black arrow)
Figure 6b: Poor resection technique: Inappropriate removal of the femoral head surface (white arrow). Normal cartilage (black arrow)
“Hip arthroscopy is often a complex procedure and should only be performed by experienced and competent surgeons. Poor surgical technique (Figure 4) can result in significant damage to the hip joint, which can be irreversible in some cases.”
Figure 7: Poor technique: Labrum has been excised revealing exposed rim of acetabulum (white arrow); Instability has resulted in significant damage to femoral head cartilage surface (black arrow)
‘Following revision surgery 80% of patients will have relief of their pain and symptoms.”
If you have undergone keyhole surgery of your hip and are still having hip pain/ stiffness and wish to discuss available options, please contact us for further advice.