4 days post op (+ operation report)

Things have been going really well since the op and I’m starting to wonder what all the fuss was about! I’ve not had any real pain to speak of. Things have certainly been sore, particularly at the anterior portal, and my ROM is incredibly limited, but it’s not as bad as I was expecting.

For the first few days I needed help to wash my lower legs and feet, and I couldn’t put my underwear, jeans or socks on, but as of today I can do all of those things. Around the house I’m down to one crutch but still need two if I venture outside. I daren’t attempt to lead up any stairs on my operated side but I hope it won’t be long before I can.

Here’s the surgeon’s operation report:

Operation Sheet - Arthroscopy of the Hip (Right)

Preparation
This was a primary procedure. Major symptoms were of posterior hip pain.
He was positioned supine on the table. The traction device used was the standard Smith & Nephew hip distractor. The portals used were lateral and antero-lateral. A cocktail of two antibiotics given as prophylaxis. The joint was “inflated” and maintained at pressure using an arthroscopic pump Arthrocare system set at 60 mm/Hg. Very tight hip with difficult access – but no chondral damage caused by instruments on entry. The arthroscopic tools used were: the Arthrocare RF “wand” and an arthroscopic burr.

Findings
The arthroscopic inspection revealed normal synovium, a normal ligamentum and no loose bodies. The abnormal findings included severe labral damage with anterolateral acetabular overhang impingement in the hip flexion. The acetabular cartilage appeared normal apart from very small posterior articular cartilage damage – grade 2 for 10 x 10 mm, there was no medial wall osteophyte and the ligament Teres was normal. The acetabular labrum had sustained what appeared to be a traumatic tear, there was no sign of degeneration. The labral tear was 10 – 15 mm in size located superiorly and antero-superior. There was minor antero-lateral chondral carpet damage adjacent to this tear.

Procedure
The femur was not treated in any way. The acetabulum treatment included debridement of the area of degeneration. The labrum was debrided back to stable articular cartilage and the anterior acetabular rim was burred back to reduce anterior impingement. The hip was moved into 90 flexion with 10 IR and no impingement was noted.

Closure
Estimated blood loss was minimal. Prior to closure haemostasis was not specifically addressed. The surgery took between 1 ½ and 2 hours. The portals were closed with an interrupted 3-0 nylon suture. Removal at 10 days by the GP practice. The procedure was performed under image guidance. Photographs were taken of the joint intra-op. For pain management the joint was injected with 20ml 0.5% marcaine into joint.

Post-operative instructions
For antibiotic prophylaxis Flucloxacillin 1 gm given intravenously at induction but need not be given again post operatively. In addition Gentamicin 120 mg given intravenously at induction but need not be given again post operatively.

Rehabilitation
Post surgery no immobilisation was required. His rehabilitation can commence as soon as he is comfortable. Discharge today or tomorrow, once mobile and safe. He will be reviewed in 6 weeks in the outpatient clinic. He will be mobilised as FWB (full weight bearing) as tolerated.