Before treatment, you will have a full consultation with a surgeon to discuss your medical history. At this point, surgery would have been suggested as a result of diagnoses or for further investigation. Your surgeon will also discuss your postoperative recovery time and any risks involved with this type of surgery.

Before surgery, we put our patients under anaesthesia which is a combination of spinal and general and give them a neuromuscular blocker. Neuromuscular blocking drugs and anaesthesia are often used to optimise surgical conditions in this type of surgery. This means the patient is unaware of the surgery and is totally relaxed, so the joint can be distracted (moved about) with minimal effect. It also reduces any pain felt after surgery.

The surgery is very minimal, with three small incisions made around the hip joint.

Paul’s technique is different to everyone else’s as he does not cut the capsule that surrounds the joint which is standard practice. This capsule also contains one of the largest ligaments in the body that supports the hip joint.

This revolutionary technique is what defines Paul’s outstanding outcomes as there is less pain, swelling, and scarring to surrounding tissues. It is a belief now that the capsular cut that is made after hip arthroscopy should be closed and yet is not in the vast majority of surgeries. Paul’s technique is not to cut the capsule in the first instance.

During surgery, the ball and socket of the joint are separated under tension, allowing for a 1 cm gap for the surgeon to access the joint itself. We do this by putting the patient into the “impingement” position by wearing an anti-rotation boot; this helps apply traction to your foot and separates the hip “ball” from the socket.

Once the surgeon has a visual (good view) within the joint, they can find the problem and proceed appropriately.

Depending on the hip joint condition and treatment, the operation can take between one and two hours.

The most common reasons for hip surgery are:

Hip Dysplasia
Hip dysplasia is the medical term used when the hip socket does not fully cover the ball. This gives a “shallow” hip joint causing pain, an unstable hip joint, a noticeable limp and in some cases, unequal leg lengths.

Femoroacetabular impingement
Femoroaetabular impingement is caused when the bones are irregular and do not fit together perfectly, causing the bones to rub against each other. This can cause clicking or popping in the hip, preventing a full range in movement and pain in the groin and buttocks.

Hip labral tears
A hip labral tear occurs when the labrum (the band of cartilage around the socket’s rim) tears. This often occurs because of stress placed in the joint during rotation, leading to pain, locking or stiffness and clicking noise or sensation when moving the joint.

Recovery can vary, but you should allow six weeks for a full recovery to allow activities of daily living and return to work as a rule of thumb. During recovery, you will need physiotherapy. Your recovery progress will depend on the damage in the joint (success of the surgery) and your rehabilitation program.

You must limit your daily activities during the recovery, including prolonged standing or walking.

We advise physiotherapy organised after being discharged and left no longer than two weeks after surgery. Your rehabilitation program is based on 9-12 months of recovery to ensure a return to sporting activity where full motion is gained and limit any further damage to the joint.

Please note: If major articular cartilage repair has been undertaken, the above time frames may be extended with extended use of crutches for up to 4-6 weeks.

We advise you to take a minimum of two weeks off, depending on your working environment. Those working in physical job placements should take longer off. You should consult your employer if your job involves –

• Heavy lifting
• Pushing or pulling of heavy objects
• Walking for prolonged periods
• Sitting for prolonged periods

Your employer may accommodate you as you recover, but we advise you to take up to two months off work if this is not the case.

You will have to use crutches for two to four weeks after surgery. This may influence your return to work.

You should avoid driving for two to three weeks after surgery or when you feel you can safely make an emergency stop.

The hip joint and, therefore, the leg may feel weak for a couple of weeks after surgery, so your ability to drive safely may be limited.

One can fly post op but one needs to be aware of their own mobility status and increased DVT risk within the first 6 weeks of any lower limb surgery. We recommend you discuss this with your surgeon.

You should rest your hip for at least 2-4 weeks before considering exercise. Start with easy low impact exercises such as swimming and cycling. You should set your higher impact target at four months when you can introduce speed walking or running.

Competitive sports or high impact games should not be considered until full recovery, which can take 9-12 months.