+ How can I prepare for hip arthroscopy surgery?

• There are many things a patient can do when preparing for hip arthroscopy surgery:
• Before opting for surgery, we recommend that patients have exhausted conservative management. Conservative management typically consists of physical therapy and injections to reduce inflammation and strengthen the musculature surrounding the hip joint. Research has demonstrated that a large portion of the population has FAI and hip labral tears which may or may not be painful. Oftentimes, conservative therapies can prevent a patient from having to undergo a surgery. Some patients do continue to have hip pain even after trying conservative therapies. However, it is still important to try these therapies as the stronger a patient goes into the surgery, the better their recovery and predictive outcomes after surgery.
• If you have exhausted your conservative management and Dr. Raynor has indicated that a hip arthroscopy is your next option for treatment, it is important to prepare for that surgery. Unfortunately, for normal/functioning individuals, there is never a perfect time to have surgery. Most patients are using crutches for 4-6 weeks after the operation, have limitations with driving for 2-6 weeks, and there is an extensive physical therapy regimen that they must adhere to. These post-operative requirements can hinder a patient's everyday life significantly. Some of these restrictions are further outlined in the questions below.

+ How long am I in the hospital?

• Typically, patients stay one night in the hospital, under "observation" status after hip arthroscopy.
• The morning after your surgery, the hospital staff will perform a dressing/bandage change for you.
• During your hospital stay, you will meet with physical therapy and have your post-operative brace fitted to you.
• If patients have no complications and their pain is well managed, they are discharged the morning after surgery.

+ What do I do with my dressing?

• Cover it when you shower for the first 3 days and change it if it gets wet or dirty. You can remove the dressing after day 3.
• You will have the first dressing/bandage change performed by the hospital staff prior to discharge.
• After that, you will leave the dressing on for approximately 48 hours before applying a new, clean and dry dressing daily. This involves placing sterile gauze over the incision and securing it with tape.
• After 5 days, you can leave the incisions open to air if they are dry and not draining. It is important to keep the surgical site and incisions clean and dry at all times to help prevent infection.

+ What are my restrictions?

• Most patients are using crutches for a minimum of 4 weeks after surgery.
• Using crutches post-operatively is important, as part of the surgery typically includes shaving down bone of the femoral neck, which slightly increases the risk of fracture at that site temporarily after surgery. As a precaution, we protect your weight-bearing status post-operatively to reduce the risk of fracture through the femoral neck.
• In order to access the joint during surgery, Dr. Raynor must make an incision in your hip joint capsule. At the conclusion of the surgery, Dr. Raynor does close the capsule with dissolvable suture. To protect the capsule and allow for adequate healing, we limit your external rotation for 3 weeks (21 days) post-operatively. This reduces the risk of post-operative instability.

+ Do I have stitches? When do they come out??

• You have a few stitches that will be taken out at your first post-operative visit. Don’t worry, they don’t hurt when they come out!

+ Can I put lotions or anything on my incisions?

• No. Please do not put any lotions, creams, oils, antibiotic ointments or anything on the incisions until they are perfectly healed and the scab is gone.

+ When can I shower?

• You can shower immediately if you cover the dressing for the first 3-5 days.
• After 3-5 days, you can remove the dressing and let the water run down over the incisions, and long as the incisions are no longer draining.
• Do NOT soak or submerge the surgical site until the surgical wounds are completely healed, typically 4-6 weeks after surgery. This includes pools, bathtubs, hot tubs, saunas, lakes, oceans, etc.

+ Will I have a brace?

• Patients will have a post-operative brace that they will wear for 3 weeks after surgery to help with the motion restrictions.
• If you are up and moving around, you should wear your brace.
• Patients do not have to sleep in the brace, and many patients choose to sleep in the CPM machine (discussed in another video).
• Patients are also given boots and a post to sleep in, if they choose not to sleep in the CPM machine, to limit the external rotation while sleeping.

+ What do I take for pain?

• You will be given a prescription for narcotic pain medication after surgery (usually Percocet/Oxycodone).
• You will also be given prescription strength Naproxen, which is an anti-inflammatory. It helps prevent extra bone from forming in the soft tissues, but it also helps with pain. You should ask your doctor about this medicine if you are on blood thinners, have stomach problems, or have kidney problems.
• The Percocet has 325 mg of Tylenol in it already, so if you are taking Tylenol, just be sure that you do not exceed 3000 mg of it in a 24 h period.

+ What medications will I be on?

• Aspirin - to prevent blood clots. Take daily for about 2-6 weeks
• An opioid for pain, usually Percocet (Oxyocdone)
• Zofran - for nausea
• Colace - stool softener
• Naproxen - an anti-inflammatory that also helps prevent extra bone formation after surgery.

+ Will I have a nerve block?

• No

+ How long do I use the continuous passive motion (CPM) machine after hip arthroscopy?

• The CPM machine is typically used for 6 weeks post-operatively, for 6-8 hours per day. Most patients choose to sleep in the machine to meet these requirements.
• The machine is initially set to allow 10-45 degrees of hip flexion and is advanced according to the patient's specific Physical Therapy protocol provided to them after surgery.
• Patients are allowed to use the CPM machine for more than 8 hours per day, but we encourage patients to get up and move after surgery, so we request they not spend more than 12 hours in the machine at a time.

+ Will I have an ice machine after surgery?

• You will be sent home with a cold gel pad, as the ice machines are hard to apply to this area. However, ice packs or bags of frozen peas work great for this as well.

+ When do I follow up after my surgery?

• Between 7-14 days afterwards. This appointment should already be made for you, but you can adjust it if needed.

+ When should I start going to physical therapy?

• Physical therapy should ideally begin as soon as possible, within 3-5 days after surgery.
• Physical therapy is extremely important following hip arthroscopy surgery in order to reduce the risk of scar tissue formation and to strengthen the muscles around the hip joint.
• Upon discharge from the hospital, patients are provided with a specific physical therapy protocol and a prescription for physical therapy.
• Patients are given some exercises to perform at home on their own for the first few days after surgery, until they are able to get into an office to see a physical therapist.

+ How long will I be going to physical therapy?

• For 3-6 months after surgery, although the frequency of visits will decrease over time.

+ How frequently do I need to go to physical therapy?

• 1-2 times/week initially, but this will be spaced out over time as you progress.

+ What are some red flags after my surgery that I should be looking for?

• Fever over 101.4 F
• Calf swelling or severe calf pain
• Increasing redness around the incision
• Pus draining from the incision. It is normal for some drainage from the incisions for a few days after surgery.
• Chest pain or difficulty breathing

+ How long is the recovery?

• As a general rule, you will be feeling OK at the 6 week mark and pretty good at the 3 month mark. You will be doing most activities by the 6 month mark, but studies suggest that you can continue to improve for up to 2 years.

+ When can I sleep on my side?

• After 3-4 weeks.

+ When can I swim?

• You CANNOT get into a pool or hot tub until your incisions are perfectly healed, usually around 4 weeks. After that, you may get into a pool and swim

+ When can I run?

• Usually around 3-6 months after surgery.

+ When can I return to sports?

• This usually takes up to 6 months to be fully functional to be able to play sports at a high level. It may happen as soon as 4 months in certain circumstances.

+ Will I play sports in a brace?

• No.

+ When can I drive?

• Patients are not allowed to drive until they are no longer taking narcotic pain medication, as this is considered driving under the influence. Due to the weight-bearing restrictions post-operatively, the restrictions about driving are different whether you have a right hip surgery or a left hip surgery. Assuming you are driving a car with an automatic transmission, restrictions are:
  • Right hip surgery -- typically patients are able to drive 4-6 weeks after the operation
  • Left hip surgery -- typically patients are able to drive 2 weeks after the operation
• Before driving after surgery, we encourage all patients to practice driving in a low-traffic area (typically a large, open parking lot), so that they can feel safe and comfortable maneuvering their vehicle. This should include practice in stopping in an emergency situation, as to not put yourself or others at risk on the road.

+ When can I go back to work?

• Returning to work depends on the type of work and demands of the patient's job. Patients are unable to return to work while they are taking prescription pain medication.
• For sedentary jobs, most patients return to work approximately 2 weeks after surgery. It can be uncomfortable to sit at 90 degrees for the first 14 days after surgery.
• Patients that have jobs that require manual labor typically cannot return to work until 6-12 weeks post-operatively, depending on specific demands.
• Keep in mind that even if you have a sedentary job, there are driving restrictions post-operatively (discussed in a previous video) that may limit your ability to get to/from work.
• Our office can provide documentation to allow work from home/remote work. Additionally, if you have the need for FMLA / extended leave, we can assist with completing that paperwork. Please note that our office does charge a fee for the additional paperwork processing.
• We recommend not making any important decisions while on the pain medication.