Hip Arthroscopy-Labrum Repair Post-Operative Instructions

The following are post-operative instructions for patients who have undergone arthroscopic labral repair to their hip. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact our office at (970) 879-BONE (2663)

CRUTCHES:
You MUST use crutches since your labrum has been repaired. On your post-op instructions the exact amount of weight bearing will be specified. You will either be told to be; non-weight bearing or touch down weight bearing. If you are allowed only touchdown weight-bearing then you will be putting just the weight of the leg on the ground. We also want you to avoid rotating your foot as you walk and move initially.

DRESSINGS:
You will have a bulky dressing over your surgical site. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap/dressing. This is very normal after arthroscopic surgery because we use water during your surgery. Some of the remaining fluid may leak out and look like blood. It is important for you to watch this area and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until the dressing is removed. In many arthroscopic procedures the dressing comes off in two-three days and you can do this yourself.

BRACES:
If a repair of the labrum of the cartilage was performed you might find a range-of-motion brace was applied to your hip. The decision for this is made based on the stability of the repair. We will preset the limits of motion on the brace. If you were given a brace, we would like you to wear the brace at all times except for showering. We would also like to avoid internal and external rotation of your foot during walking.

SUTURES:
The sutures utilized in closing any wounds are either an absorbable suture, nylon suture or staples. You are not to remove them under any circumstance. Sutures will require more time to heal and should only be removed by your doctor. This is usually done between 7-14 days. This may be shorter or longer depending on your procedure.

ICE:
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping your leg above the level of your heart. You can keep ice packs on the hip for 20 min every few hours during the first few days. Once you have removed the original dressing and reapplied only Band-Aid to the wounds use some cloth cover between the skin and the ice packs. Gradually as pain and swelling decreases so does the need for routine icing and can be used as necessary.

SHOWERS:
You may or may not be able to shower immediately after surgery based on the type of dressing that was applied at the end of your surgery. You will be told at the time of discharge from the hospital when you can shower. If there is any noticeable or persistent drainage from the incision sites, or any surrounding red areas, please contact us immediately. DO NOT SUBMERGE YOUR SURGICAL INCISION UNDER WATER (hot tub, bath tub, lake, pond, river, etc).

PHYSICAL THERAPY:
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent with hip rehabilitation, so you are free to select your therapist.

Although formal physical therapy is not 100% essential to obtain a good result with arthroscopic hip surgery, we believe it is definitely helpful in achieving the quickest and smoothest course to full recovery. Please schedule your therapy to begin within a few days following surgery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately.

Isometric Quadriceps/gluteal Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down. Then repeat this with the gluteal muscles (buttock). Laying down you can lift your head and hold to get a good core or abdominal isometric muscle work.

Range of motion: Unless instructed otherwise, we encourage you to increase motion of your hip as soon as possible, within your comfort range. Bend and straighten your hip while sitting, standing, or lying down. Increase motion as tolerated. In the sitting position, you may do heel slides with the foot supported by the floor. Laying prone (on your stomach) for periods of time is good to prevent tightening of the hip capsule. You may have a brace for support and we will specify if it is to be removed for motion exercises.

Ankle pumps/toe curls: Pump your ankle up and down frequently throughout the day to keep blood flowing and prevent blood clots. Also, curling the toes tightly activates the foot muscles which act as a pump for blood.

FIRST OFFICE VISIT AFTER SURGERY:
We try to schedule your first post-operative visit prior to your arthroscopic surgery. If you do not, we call all patients the day after your surgery and your first post-operative visit can be scheduled at that time. This first visit is usually two or three days after your surgery. If you live very far away, special consideration is given and other arrangements can be made (e.g. you live in the Winter Park, Granby, Craig or Kremmling area).

MEDICATIONS:
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe Hydrocodone or Oxycodone. These are both generic names for two different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery. You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. Tylenol and Acetaminophen are the same medicine. You should not use Tylenol if you are using the Percocet/Roxicet or Lorcet prescription medications since they already contain tylenol/acetaminophen. If in doubt check the prescription label to be sure acetaminophen is not in your medication. We try and avoid over-the-counter anti-inflammatory medications such as Ibuprofen (Advil, Aleve, Nuprin, etc.). If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid using Toradol. Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends, so please plan ahead.

COMPLICATIONS:
Arthroscopic hip surgery is a fairly straight forward and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the hip, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a small incidence of a blood clot developing deep within your leg veins. This would be characterized by a sudden onset of new pain (usually different from your surgical knee pain) or tightness in the back of your thigh, calf, or knee. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. If you have a past history of blood clots, or family history, we will want to know this to provide a medication for the prevention of blood clots.

Contact our office for any concerns at 970-879-BONE (2663).