Surgery for Hip Impingement Syndrome

If hip impingement syndrome causes significant pain and symptoms don't improve with nonsurgical treatment or therapeutic injections, our orthopaedic surgeons may recommend surgery. They can reshape the bones in the hip joint, so that the round femoral head can rotate smoothly within the socket-shaped acetabulum.

By correcting the structural problem in the joint and removing the source of friction between the bones, surgery may prevent further joint damage, including osteoarthritis.

Orthopaedic surgeons at NYU Langone may use one of several surgical techniques to treat impingement. They consider factors including your age, the extent of the structural problem in the hip joint, the presence of cartilage damage, and whether you’ve had previous hip surgery. These procedures are performed using general anesthesia.

Hip Arthroscopy

Hip arthroscopy is a surgical procedure that allows surgeons to access the hip joint through very small incisions, minimizing damage to nearby muscle and other soft tissues.

To perform arthroscopy in the hip, a surgeon inserts a pencil-sized instrument called an arthroscope into the joint through a small incision. The arthroscope has a light and a camera lens at its tip. The camera captures live images of the inside of the hip. These images are broadcast on a monitor, allowing the surgeon to accurately navigate the joint.

After the arthroscope is positioned correctly, the surgeons uses small instruments—for example, a miniature chisel—that are inserted through a second small incision to reshape the femoral head or acetabulum. This reshaping of the bone is called osteoplasty. By removing excess bone growth on the femoral head or modifying the shape of the acetabular rim, surgeons restore a perfect fit for the components of the joint.

Surgeons may also repair a hip labral tear or damaged cartilage during arthroscopy. After the procedure is done, the incisions are closed with dissolvable stitches.

What to Expect After Surgery

Arthroscopic surgery is almost always an outpatient procedure, and you can expect to go home within hours of surgery. Most people are able to walk with crutches almost immediately after the procedure. Our pain management specialists ensure you have the medication you need to remain comfortable during recovery.

Doctors recommend using crutches for two to three weeks. Your surgeon schedules a follow-up appointment for two weeks after surgery to confirm that the incision wounds are healing normally. Your surgeon also examines your hip and asks you to rotate your leg gently in different directions to assess its range of motion after surgery.

Our doctors recommend starting physical therapy in the days after surgery. Physical therapy helps you to rebuild muscle strength, flexibility, and range of motion in the hip.

Surgical Hip Dislocation

Surgeons may recommend a surgical hip dislocation if they confirm that large bone growths have developed on the femoral head or acetabulum. They may also suggest this procedure if the labrum—a tough ring of cartilage that surrounds the outer rim of the joint—has been torn. Surgical hip dislocation gives surgeons open access to the entire hip joint, making repairs easier.

A surgeon makes an incision at the side of the hip and moves aside a small part of the upper femur, or thighbone, so that he or she can better access the hip joint. The surgeon puts the bone fragment back into place after the joint is repaired.

Surgeons use instruments, such as a chisel, to perform osteoplasty, so that the hip bones fit perfectly together. In addition, surgeons may repair a torn labrum, ensuring that this layer of cartilage fits snugly around the rim of the acetabulum when the femoral head is put back into place.

Finally, the surgeon uses two or three metal screws to secure the femur bone fragment back into place. The incision is closed with stitches or staples.

What to Expect After Surgery

After the anesthesia wears off, you may feel pain at the site of the incision. This is normal, and NYU Langone pain management specialists immediately work with you to make sure you are comfortable while your body heals.

As soon as you feel capable, NYU Langone physical therapists help you to stand and walk. They may provide crutches or a walker to help you avoid putting weight on the hip. Getting out of bed and standing or taking a few steps is important to retain strength in your muscles and joints. It also helps you avoid complications that can result from being immobile, such as deep vein thrombosis, a blood clot that obstructs blood flow.

Our doctors recommend starting physical therapy during the first week of recovery to rebuild muscle strength, flexibility, and range of motion.

Most people leave the hospital after one to three days and return about two weeks later for a follow-up examination and to have the stitches removed. Crutches are required for approximately six weeks.

Your doctor may recommend over-the-counter or prescription medication to relieve pain at the site of the incision and in the hip while the tissue heals.

Periacetabular Osteotomy and Femoral Osteoplasty

Periacetabular osteotomy, also known as Ganz osteotomy, is a procedure to reposition the hip socket, or acetabulum, in order to correct a pincer impingement, provide more stability if you have developmental hip dysplasia, or to ensure a better fit for the ball-shaped femoral head.

Femoral osteoplasty, in which the femur is reshaped to better fit into the hip socket, may be performed if you have cam impingement, in which a misshaped femoral head is the cause. Your surgeon determines if this procedure is appropriate based on the results of diagnostic imaging tests.

During this procedure, the surgeon makes an incision on the front of the hip to access the joint. He or she then separates the acetabulum from the rest of the pelvic bone. The acetabulum is rotated, so it matches the alignment of the femoral head, and is fixed into this new position with metal screws. Doctors close the incision with stitches or staples.

What to Expect After Surgery

After surgery, you remain in the hospital for several days while the bone begins to heal. During this time, our pain management specialists ensure that you recover comfortably and have the medication you need. In addition, a physical therapist visits you and assesses your range of motion. He or she also helps you stand and walk using crutches or a walker.

Doctors schedule a follow-up appointment to remove stitches or staples two weeks after surgery. Crutches or a cane are required for at least six additional weeks. When you can walk without pain, our specialists recommend starting physical therapy to rebuild strength and range of motion in the hip.

Total Hip Replacement

If you experience chronic hip pain because of joint damage caused by osteoarthritis and have difficulty walking or exercising because of joint stiffness, doctors may recommend surgery to remove the diseased joint and replace it with durable prosthetic parts. Total hip replacement eliminates osteoarthritis in the hip and may dramatically improve your quality of life by alleviating pain and restoring stability and range of motion.

A surgeon performs total hip replacement using spinal anesthesia or general anesthesia. He or she makes an incision along the front, side, or back of the hip to access the hip joint.

The surgeon removes the arthritic joint as well as loose pieces of cartilage or other tissue. He or she then puts the prosthetic parts in place and closes the incision with stitches. Pain medication is injected into the surrounding tissues of the hip to help control pain after the procedure.

What to Expect After Surgery

As soon as you are capable, NYU Langone physical therapists help you to stand and walk. Getting out of bed and standing or taking a few steps helps you to retain strength in your muscles and joints, increases blood flow to the hip and leg, and may help speed your overall recovery.

Physical therapists monitor healing and continue to help you learn to walk using your new hip. Pain management specialists work with you to ensure you are comfortable while your body heals.

You can go home as soon as you can walk independently. That may be on the same day as surgery or one to three days later, depending on how quickly you recover.

After you can walk unassisted and without pain, NYU Langone physical therapists can help you to rebuild muscle and increase flexibility and range of motion in the hip. Our rehabilitation doctors and physical therapists customize an exercise routine that you can do at home to continue to condition and strengthen your muscles. Physical therapy should continue for 6 to 12 weeks, at which time NYU Langone doctors assess your progress before determining if additional physical therapy is needed.

Most people return to the hospital for a follow-up examination two to four weeks later. Crutches, a cane, or a walker are usually required for two to four weeks.

Today’s new joint implants are made with more durable material than in the past. The majority of people with a prosthetic hip have no complications for 20 years or more. This longevity means that total hip replacement is now an option for young, active people, for whom this surgery may be the best option for eliminating chronic hip joint pain.

After 20 years, a small number of joint implants begin to wear out and may need to be replaced. Our doctors recommend annual or biannual appointments after surgery, so that our specialists can ensure your hip implant continues to work well.

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