Ask the Expert: Dr. Geoffrey Westrich, Orthopedic Surgeon, Answers Your Questions About Hip Arthroplasty vs. Hip Arthroscopy
Q1. I need hip surgery – what determines if I need arthroplasty or arthroscopy surgery?
If you have hip arthritis, arthroplasty (hip replacement) is needed to remove the diseased hip structures and replace them with an artificial implant. Hip arthroscopy is a minimally invasive procedure to repair hip injuries, using small cameras that are fit through tiny incisions in order to view the hip. However, while this procedure is successful for many patients, such as those with labral tears, it does not have a good outcome if you have arthritis, even if you have a tear in the labrum, which is a rim of rubbery cartilage around the hip socket that seals in joint fluid and maintains lubrication and nutrition.
Q2. I had a total hip replacement three years ago and recently I started experiencing some discomfort and swelling in the immediate surgical area. Is this a sign of infection or rejection?
There are many causes of pain several years following hip replacement surgery. Some are relatively easy to solve and some are more complex. If you’re experiencing pain it is always best to visit with your surgeon for an evaluation as soon as you can. This should include a physical examination as well as x-rays. If an infection is suspected, your surgeon should consider blood tests and possibly an aspiration of the hip under fluoroscopy, which involves removing fluid from the hip joint to test for infection.
Q3. What is the recovery like for hip arthroscopy and arthroplasty surgery?
For hip arthroscopy, recovery may vary depending upon the patient, the extent of the surgery and what was found at the time of surgery. Traditionally, patients can walk with crutches and put weight on the limb after leaving the hospital. However, depending upon the specific surgery that was performed during the hip arthroscopy, patients may need to remain on crutches for several weeks. For a hip arthroplasty, patients are usually able to bear full weight and are generally sent home after the surgery with a cane.
Q4. I am an athlete. How likely is it that I will be as active after hip arthroplasty surgery?
Most patients who are active will continue to be very active following hip arthroplasty. In many cases, patients can return to many of the activities that they have been unable to do for years. However, orthopedic surgeons still recommend non-impact activities, like biking, swimming, golf, double tennis, and caution over high-impact type activities, such as running and jumping. It is always best to review this with your surgeon both before and after surgery so that the patient has realistic expectations.
Q5. Will my arthritis pain improve after my hip arthroscopy surgery?
Your arthritis pain will likely not improve and may even worsen following hip arthroscopy surgery. Hip arthroplasty is recommended to treat patients with hip arthritis pain. Please refer to my answer to the first question.
Dr. Geoffrey Westrich, Orthopedic Surgeon, specializes in knee and knee replacement, including revision surgery and complex cases at Hospital for Special Surgery. He is director of research of the Adult Reconstruction and Joint Replacement Service at HSS.