Osteotomies around the hip joint

Labral Repair


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What is it and why?

  • This procedure is performed under general anaesthesia.

  • The bone is divided then ‘rotated’ to gain better cover for the ball. The shifted socket is stabilised with two or more screws.

  • By doing this, the forces through the joint are shifted to normal or less damaged parts of the hip, potentially prolonging the life of the natural joint.

  • This is offered to carefully selected patients who have a poorly developed socket (dysplastic acetabulum) or ball part of the hip (femoral head).


  • Treatment does not involve Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment does not involve Daycase procedure
    Daycase procedure
  • Treatment involves Inpatient procedure
    Inpatient procedure
  • Treatment does not involve Local anaesthetic
    Local anaesthetic
  • Treatment involves General anaesthetic
    General anaesthetic
  • Treatment does not involve Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Painful for 2+ weeks

  • Mobility
    Mobility

    Affected 2+ months

  • Daily activities
    Daily activities

    Affected for 2+ weeks

  • Driving
    Driving

    No - 3+ months

  • Leisure activities
    Leisure activities

    Affected 2+ months

  • Light exercise
    Light exercise

    Affected 2+ months

  • Heavy exercise
    Heavy exercise

    Affected 6+ months

  • Light work
    Light work

    Affected 2+ months

  • Heavy work
    Heavy work

    Affected 6+ months

  • Intimate
    Intimate

    Affected 2+ months


Overview

What does it involve?

  • Osteotomies around the socket are called peri-acetabular osteotomies and those around the thigh bone (femur) to bring the ball inside the socket are called femoral osteotomies.

  • Peri-acetabular osteotomies are considered major surgeries and may not be appropriate for many patients. It is usually offered to patients below the age of thirty after selection based on strict criteria. Your surgeon will be able to tell you if you’re eligible for this or another form of osteotomy.

Effort/burden

  • You must consider and accept the specific risks of this operation, as well as more general risks associated with a major operation.

  • It may take up to six months to recover from this operation. You will have to use crutches during mobilisation in the initial stages.

  • There are some limitations and precautions you will have to observe to decrease the risk of complications.

  • You may not be able to drive a car for a few months, or even longer depending on your recovery rate.

Benefits

  • There is some evidence to support osteotomy surgery may prevent or delay the onset of arthritis.

  • Clinical success as recorded with patient outcome measures, such as Oxford Hip Score’s, are used to monitor your progress.  

Limitations and side effects

  • You should consider all limitations and side effects of a major operation.

  • Your scar may be sensitive for a few months after the operation. As a result, you may not be able to lie on the side where your operation took place.

  • Immediately after the operation, pain is likely to get worse before it gets better. Medications will be provided to help you with this.

  • Hip pain may not completely decrease, but is likely to improve significantly.

  • If the procedure is performed arthroscopically, you may also have soreness around the perineum and swelling that lasts between a few days and a few weeks.

  • There may be side effects from the medication, especially painkillers, antibiotics or anaesthetic agents. These include skin rash, constipation, liver or kidney damage etc. Please ask your doctor if you wish to know more.

  • While you recover from the operation you will need to use physical aids such as crutches or a frame which may have an impact on your ease of mobility.

  • You will need to take care of the area that was operated on. This may mean being more careful with dressing and wound care - the outreach nurse or practice nurse from your GP will help you manage this.

  • You will need to attend your GP practice or hospital for a wound check and follow-up appointments.

  • You will need to go to the physiotherapy department regularly to get the most out of this surgery.

  • Your work, activities of daily living, walking, sleeping, intimate relationship, family life, leisure activities and driving will all be affected for a few weeks to months after this procedure.

Risks

  • You will need to accept the unpredictable nature of the outcome of this procedure and its ability to prevent the development of arthritis. Your surgeon will advise on your chances of success based on your condition.

  • General risks: Heart related problems (heart attack, irregular heartbeats), lung-related complications (pneumonia, lung collapse), post-operative confusional state, post-operative decline of brain function (cognitive decline), kidney failure, urinary tract problems (infection or retention with the need for using catheter), nerve damage, damage to blood vessels, deep vein thrombosis (DVT), pulmonary embolus (PE), complex pain, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery (like lips/teeth/throat, eyelids etc) regret of undergoing surgery and death.

  • Specific risks: Pain, bleeding, swelling, stiffness, superficial infection, inflammation, sensitive scar, change in appearance of the operated area, puckered scar, thick scar, numbness, failure of tendons or muscles to heal, deep infection needing further surgery, nerve injury, avascular necrosis, perineal pain, back pain, ectopic ossification etc.

Cost

  • This is a very high-cost option for both patients and the NHS.

  • Patients: You will need to take time off work, have help during the initial recovery stages and visit the hospital and physiotherapy department. This may involve paying for taxis, parking or favours from friends and family.

  • NHS: Generally expensive, costing approximately £8,000 to £10,000 per procedure. However, the cost can be much more should a complication occur and require treatment.

What if no treatment is done?

  • Ongoing pain.

  • Your arthritis may deteriorate and affect your activities of daily living, family life, work environment and leisure activities.

  • If the condition progresses, more complex and demanding procedures may be required.

  • If your arthritis progresses significantly, no further treatment may be available. You may regret not opting for treatment earlier.


Labral Repair