Your Hip Arthroscopy at HSS: What to Expect

Anna Westrick, MD
2009-2010 Regional Anesthesia Fellow
Hospital for Special Surgery


The following is a helpful timeline to help you understand and prepare for your experience at HSS. Although the following outline of a hip arthroscopy is a typical one, please keep in mind that your experience may differ.

The Weeks and Days Before Your Surgery

When scheduling your procedure with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Most likely, you will go home the same day; alternatively, you might be required to stay in the hospital for a few days. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.

  • Clearance: If your hip surgery requires you to stay overnight in the hospital, you will be referred by your surgeon to an internist for clearance for surgery. If you have a history of medical problems - even if you are scheduled to go home the same day as the surgery – your surgeon will often advise you to obtain pre-operative medical clearance. This clearance includes a history and physical exam, and possibly some laboratory tests. If your particular medical condition requires it, additional tests such as an EKG or chest x-ray will be ordered at this time.
  • Medications: You may be instructed by your surgeon or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin) several days to a week before your surgery. In addition, you may be instructed to take some of your medications the morning of surgery even though you will not be allowed to eat that morning. It is important for you to bring a list (or a bag of pill bottles) including all your medications to your medical clearance. This includes vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery).

The day before your scheduled procedure, a perioperative nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, and you will be reminded not to eat or drink anything after midnight. This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water. Be sure to follow the nurse’s recommendations strictly, as your surgery might otherwise have to be rescheduled.

The Morning of Surgery

On the day of surgery, you will arrive at HSS at the designated time, often several hours before your surgery is scheduled to begin.

  • The “Holding Area”: You will come to the preoperative “Holding Area”, where dedicated staff will help prepare you for surgery. If you are unsure of where to go, please ask at the Information Desk in the HSS entry foyer. A locker will be provided for your belongings, but please leave any valuables at home. You will be asked to remove all jewelry before entering the operating room. You will then change into a hospital gown and be assigned a bed in the Holding Area. A nurse will start an intravenous line to give you fluids. If you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.
  • The Preoperative Exam: Next, a Physician’s Assistant (PA) will take your history and perform a physical exam. The main purpose of this examination is to see if anything has changed since you last saw your medical or surgical physicians. You will be asked to confirm what type of surgery you are having and asked to sign consent for that surgery if you have not already done so. Your surgeon will speak to you and sign your surgical site and identification band. This is simply a safeguard to confirm where on your body the surgery will be performed, and that your personal information is correct. At this time, you will also meet your anesthesiologist, who will discuss what type of anesthesia you will receive.

Anesthesia

The anesthesiologist will review your medical history and medical chart. They will also confirm the correct site of your operation and explain the anesthetic plan. Hip arthroscopy can be performed under general anesthesia or regional anesthesia. At HSS, over 90% of hip arthroscopy procedures are performed under regional anesthesia.
 
Regional Anesthesia for hip arthroscopy surgery is a spinal or combined spinal-epidural anesthesia. When you receive this type of anesthesia, you will feel no pain during the surgery. As a result, you will need less sedative and pain medication, which makes your recovery faster and more comfortable with fewer side effects such as sleepiness and nausea. You will be comfortably sedated before a spinal and/or epidural and will remain sleepy for the surgery.

Spinals and epidurals involve the injection of local anesthetic in the lower back that numbs the nerves going to the hip. Both of your legs will be numb - from your hips down to the tip of your toes - after the spinal injection. If an epidural is needed, a small, plastic epidural catheter will be placed at the site so that more local anesthetic can be infused as needed during the operation. At HSS, most procedures are done under spinal and/or epidural with sedation.
 
General Anesthesia may be used if regional anesthesia is contraindicated. General anesthesia involves being put to sleep with medications that are given through your intravenous line. Once you are completely asleep, a breathing tube is placed into your mouth and your anesthesiologist will assist your breathing with a ventilator. You will be asleep and comfortable until the surgery is complete. Once the procedure is over, you will start breathing on your own, the tube in your mouth will be removed, and you will wake up in the operating room.

After having reviewed the plan for anesthesia and making sure all of your questions are answered, you will be presented with the anesthesia consent form to sign.


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The Operating and Recovery Rooms

Anesthesia/Surgery: After your consultation with the anesthesiologist, you will be taken to the operating room by your nurse. Once there, your anesthesiologist will put you on monitors to measure your blood pressure, heart rate, and oxygenation of your blood. You will have supplemental oxygen given to you by nasal cannula (a small tube under your nose), and you will be given rapidly-acting sedatives. The pre-planned anesthesia will be administered, and then the surgery will begin. When the surgery is complete, your surgeon may speak with your family and your anesthesiologist will transport you to the recovery room.

Recovery: After the surgery, you will be transported to the recovery room where your vital signs will continually be monitored and you will wake up from the sedation. If you have received regional anesthesia, you may initially not be able to feel or move your legs. The sensation and movement will gradually return and pain medications will be provided upon request. As you become more awake, you will be given light snacks and drinks and will be able to receive visitors. Your surgeon or member of the surgical team will speak to you about the surgery. You will be given detailed instructions on how to care for yourself at home and will be given prescriptions for pain medicines.
 
Hip arthroscopy surgery is often considered a “same day procedure,” meaning you may have surgery and be discharged on the same day. Once you have received your discharge instructions and prescriptions for pain medicines to take at home, you are ready to go. Please make sure that you have someone who can escort you home, as required by hospital policy after undergoing any type of anesthesia.

The Recovery Process

Physical Therapy: The recovery process will be an active one. You will likely begin working with a physical therapist the day after your surgery. This is an important part of your recovery that will allow you to get back to your normal activities as soon as possible.

Updated 12/5/2011 by Shawna Dorman, MD


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