For hip conditions that have not improved with nonsurgical care, surgical intervention may be an option.

Our hip preservation program utilizes minimally invasive treatments to help young and active adults resume an active lifestyle more quickly. Reshaping and repairing the hip joint restores the anatomy of the hip and gives patients the greatest chance of maintaining a healthy hip, with reduced pain and improved function.

Some of the common procedures we perform include hip arthroscopy to repair labral tears or bone problems, hip subchondroplasty for cartilage damage or mild degeneration and direct anterior total hip replacement.

Before Surgery

Physical Therapy
Many patients will attend physical therapy or complete a home exercise program for core and gluteal strengthening to see if symptoms alleviate prior to proceeding with surgery. Many patients will complete traditional land based therapy, but aquatic physical therapy can also be appropriate for some patients.

Scheduling
You will meet with an administrative assistant to schedule your surgery. He or she will help you pick a surgery date, and give you more information about the location of the surgery and other instructions to help you prepare for surgery. They will have you sign a Surgical Consent Form, which gives us permission to proceed with surgery. 

You will have an assessment to review your medical history and determine if testing is necessary. Depending upon your age, medical health and smoking status, you may need pre-admission testing to identify any issues that could complicate the anesthesia or surgery, and whether or not you are healthy enough to safely undergo surgery.

Medication and Supplements

Before your surgery, tell your doctor during your appointment about any medicines you take, including vitamins and supplements. Keep these general points in mind:

  • Do not take any herbal medicines or supplements for up to 14 days before surgery.
  • Do not take non-steroidal anti-inflammatory drugs (NSAIDs) for up to 10 days before surgery, including naproxen (i.e., Aleve) and ibuprofen (i.e., Advil or Motrin).
  • If you take any medicine to thin your blood or to prevent blood clots make sure to discuss with both your surgeon and your prescribing physician whether you should stop your medication prior to the surgery.
  • If you take medicine for diabetes, you may need to stop or change your dose before surgery. Talk to the doctor who manages your diabetes to see how you should adjust your medication the day of surgery. Also, you will need to check your blood sugar the morning of your surgery. If it is above 250 or less than 70, call your doctor for more instructions. High or low blood sugar may result in a delay or cancelation of your surgery.

If you are a smoker, or use other tobacco products, quit at least four weeks before and for as long as eight weeks after surgery to help your wounds heal and to reduce your risk of infection.

Please have a family member(s), or friend(s) there to help on the day of your surgery. You will need them to take you to and from the hospital on your surgery date (you will not be allowed to drive home), to help access essentials at home and to assist with cold therapy. 

 

Prepare for hip surgery

Many hip arthroscopy patients will require a hip brace for a short period of time after their surgery. This is set up through the surgeon’s office. You will need either crutches or a walker to help you walk after your hip surgery. Your surgeon’s office can help you obtain these the day of your surgery if you don’t have these readily available.

Physical therapy will start 1-3 days after surgery depending on your surgeon’s preference. You will need to contact your clinic of choice to schedule this. Please refer to the information received from your surgeon for when to start these sessions.

You may need to arrange transportation to and from appointments for a short period of time after your surgery. We ask that patients do no resume driving until they are off of all narcotic pain medications and off of crutches or walkers. The surgical leg should also be pain free and strong enough to operate the car safely.

You will receive a call one to two days before your surgery to give you your surgery and arrival times. Before you arrive for surgery: 

  • Do not shave anywhere on your surgical leg.
  • Do not eat, drink or smoke after midnight the night before your surgery. This includes no gum, breath mints or candy. Brush your teeth and rinse your mouth, but do not swallow anything.
  • You MAY have up to 20oz (ounces) of CLEAR LIQUIDS between midnight and up to 2 hours before your arrival time for surgery. Clear liquids include plain water, apple juice, Coke or Sprite, sports drinks, plain tea and black coffee (NO milk or cream). You may take your morning medicine with water.
  • Take a shower the evening prior and the morning of surgery using the anti-microbial (CHG) soap provided to you by the office staff. 
  • Do not put anything on your skin such as makeup, lotions, deodorant, perfume or cologne.
  • Do not wear contact lenses, jewelry/body piercings or nail polish.

You should wear comfortable, loose-fitting clothing. Leave your valuables at home, including jewelry and money. Bring only these essentials to the hospital: photo ID; insurance card; your co-pay; a list of medications and dosages; and cases for dentures, glasses and hearing aids, if worn.

 

 

The Surgery

Typically, hip surgery may last anywhere from two to three hours.

What to Expect During Surgery

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The Operating Room

The anesthesiology team and your nurse will take you to the operating room. You and your care team will complete a sign-in procedure to verify the correct patient, consent, surgical site marking, medication allergies and the surgery to be performed.

Once those steps have been completed, anesthesia is administered through your IV. Once you are fully asleep, we position and pad your body to protect the areas we are not performing surgery on. The surgical hip is then prepped and draped to properly prepare it for surgery.

Before beginning, the surgeon verifies with the surgical team on which side your surgery is being done, the type of surgical procedure(s), your medical allergies and any other special considerations or needs for your case.

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Arthroscopic Hip Surgery

Some hip surgeries can be performed using arthroscopy, which means that the surgeon will use small incisions in your hip, called portals, to perform the surgery. A camera is inserted in one of the portals which allow the surgeon to see into the hip joing in better detail. Other tools necessary for the surgery will be used through these portals as well. After the surgery, these portals are closed using suture and covered with a clean bandage.

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Open Hip Surgery

Some hip surgeries will require a larger incision into the hip which allows the surgeon more access to successfully perform the surgery. After the surgery, the incision is closed using suture or staples, and covered by a clean bandage.

After surgery, you will be brought out of anesthesia and transported to the post-anesthesia care unit (PACU). You will remain there for typically two hours. Your family will be allowed back to the recovery room about 45 minutes after surgery.

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Same-Day Surgery

Depending on your surgery, you may be allowed to go home the same day. If this is the case, plan on being at the hospital for 6-8 hours from check-in to discharge. You must have a responsible adult (over 18) to drive you to your procedure, stay during your surgery, meet with the surgeon to listen to discharge instructions and stay with you for 24 hours after transporting you home.

For same-day surgery, the nurse will review instructions regarding pain control, sling use, bathing, dressing change, restrictions, exercises and medications with you and the person driving you home. Once you have recovered enough and are stable, you will be discharged.

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Inpatient Surgery

Certain surgeries may require you to stay at least 1 to 2 nights in a hospital after surgery. This is to monitor you while you recover, and to control the pain. You may want to pack an overnight bag in the event that you are admitted to the hospital.

For inpatient surgery that requires you to stay overnight, you will be admitted to the hospital for 1-2 nights depending on your surgery and pain control. During your stay, a physical therapist, occupational therapist and hospitalist may visit you. You will also be visited by our resident and/or the surgeon.

You will go home with a medication for pain control and an anti-inflammatory if appropriate for you based on your health history.

The effects of anesthesia may remain for 24 hours or longer. Do not drive, operate equipment or make important decisions during this time.

Post-Surgical Care

These instructions are a general guideline, because no patient or procedure is the same. If needed, your surgeon will give you further specific instructions.
 
PROTECT YOUR HIP
  •  No prolonged sitting, standing or walking, no planting and twisting on your surgical leg, no repetitive actions such as sweeping, mopping, gym exercises, etc. You should wear your hip brace as prescribed if one was provided for you.  
COLD THERAPY
  • Ice and compression can help with swelling and inflammation and decrease pain after your surgery. This can be accomplished in multiple ways and will be discussed in more detail at your pre-operative visit.

INCISION CARE

  • You will have stitches. Please keep your incisions clean and dry and do not submerge them in any form of water. Please do not use any lotions, soaps, ointments, alcohol, or antibiotic creams on your incisions.

BATHING

  • Keep your incisions clean and day. Covering each incision with a waterproof bandage during showers will help protect them. 

MEDICINE

  • You will be given a list of your medications upon discharge from the hospital. These will include a nonsteroidal anti-inflammatory drug (NSAID) if appropriate for you, a blood thinner and pain medications. Dosages of these medications will be outlined in your discharge instructions. Each surgeon has different medication regimens, and the medications will be selected based on your surgery, current medications and your health history. 

EXERCISE

  • Exercise should be limited to physical therapy in the clinic and approved activities as discussed with your surgical team and physical therapist (PT). You will be provided a home exercise plan and this will be reviewed at each visit with your PT. Additional exercises will be added based on how you are progressing with strength and function.

FOLLOW UP APPOINTMENTS

  • Your first follow-up appointment is generally 10-14 days after surgery. Normally this will be with one of our physician assistants.   Please refer to your preoperative packet for the date and time.  If you do not already have this appointment scheduled, please contact the office after surgery to schedule this appointment.  
  • The timing of the start of physical therapy will begin depending on what surgery you have. More information will be provided to you pre-operatively, and also at your first post-operative appointment
  • Wound care, pain management, and a review of your surgical procedure will be discussed at your first post-operative appointment
  • Additional appointments are scheduled according to the type of surgery that you had and how you are progressing. 
 
PRECAUTIONS 
  • Call your doctor if you experience any chest pain or pressure, difficulty breathing or calf pain or swelling. These can be signs of blood clots and need to be discussed with your health care team so that proper guidance on treatment or evaluation can be given. You should monitor your incisions for any signs of infection which can include redness, drainage, swelling or increased pain.
  • Rest for the first 24 hours after surgery.  General anesthesia may cause a sore throat, jaw discomfort or muscle aches.  These symptoms can last for several days. Do not drive, drink alcoholic beverages or make any important or legal decisions during this time.  
  • Keep your first few meals after surgery light and drink plenty of fluids, as some people are nauseous after surgery.
  • Smoking increases your risk of infection and can delay healing times.  If you smoke, you are encouraged to quit, cut back or at least quit smoking during the postoperative period.
  • Pain medications are important for the first few days after surgery to treat postoperative pain, but addiction, tolerance, and side effects are important concerns.  Decrease the pain medications as soon as you can tolerate (this is typically after the first few days).  Most patients require narcotic pain medications only for the first few weeks after surgery (even complex procedures).  Prolonged use increases the risk of problems with these medications.
  • If you have any concerns about pain medication use, or its potential side effects, please contact our office. 
 
NOTIFY SPORTS MEDICINE IMMEDIATELY IF YOU DEVELOP ANY OF THE FOLLOWING:
  • Increased redness or swelling over the incision area
  • Incision area is warm or hot to touch
  • Incision has foul smelling drainage 
  • Relentless pain, nausea, vomiting, bleeding or drainage
  • Severe calf pain or chest pain
  • A fever greater than 101.4 more than 48 hours after surgery
If it is an emergency that requires immediate attention, go to the nearest emergency room or call 911. Otherwise, contact our office with any questions or concerns. After normal office hours, this number will also get you in contact with the on-call orthopedic doctor.

Returning to Activity

The vast majority of our patients are back to their normal activities in six to nine months. While some patients recover faster, it can take up to one year for some patients to fully return to normal activities. 

For the first 12 weeks of recovery, the goal is to regain some of your range of motion in the shoulder. Strengthening the shoulder does not typically start until 12 weeks after surgery. 

For our active patients, you may begin an exercise program as soon as your wounds are healed (generally two weeks after surgery). During the first two to nine weeks postop, a stationary bike, walking, CORE strengthening and lower body strengthening are acceptable. After the nine-week mark, you may start jogging if cleared by your surgeon. No upper body strengthening will begin until your doctor and physical therapist approve it. 

If you are an athlete who is returning to sport after shoulder surgery, here are important considerations:

Stay involved with your team. You can still be learning, observing or encouraging teammates on the sideline even though you are injured. Helping track team stats and/or documenting the practice plans can help you achieve mental engagement with the team.

Walking, stationary cycling (recombinant bicycle), lower extremity strengthening and rehab exercises are all options to discuss with your physical therapist or athletic trainer. Be certain that you are protected from any plays, passes or equipment that could cause injury to your shoulder. If your shoulder begins to bother you at any time, stop activity and apply ice.

Every athlete recovers at a different pace. You might feel fit and ready to return, but you should verify the plan with your physician, physical therapist and/or athletic trainer. Be sure to keep your coach involved in the rehabilitation process as well.
 

Return to activity varies greatly from patient to patient and depends on the activity. In general, return to activity should be gradual, and you should pay close attention to if the activity causes any increase in pain. Return to run/exercise programs typically start around 12 weeks after your surgery. You should discuss activities and activity with your surgical team and physical therapist(s) to determine timing that is safe for the hip.  

The goals of physical therapy after hip surgery are to ensure that the hip, core and gluteal muscles are strong and that the body is stable and safe to return to activity. 

 

 

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