Timeline

Together with your treating specialist, you've chosen to have keyhole surgery on your hip. The request for the operation has been submitted and the process is now underway. Your specialist has discussed everything with you. You've also been given information in the form of a patient leaflet, and pointed towards the information on the website heupscopie.nl. All together, that's a lot of information, and not all of it is relevant straight away. This timeline gives you day-by-day information at the moments it matters most to you. Sometimes it's more background reading, but sometimes there's something you'll really need to arrange...

To increase your chances of a successful result, it's important to stop smoking around the time of your operation! Scientific research has shown that this leads to better wound healing and a lower risk of infection, for example. There are also fewer lung problems. Stopping four weeks before and four weeks after the operation already reduces the risk of problems considerably.

Everyone knows that stopping smoking can be quite a challenge for many people. But you're not alone in this. Your chances of successfully quitting increase with good guidance and support. Talk to your GP about how you can get help, or take a look at the website ikstopnu.nl. For many people, an operation is a good motivation to finally quit for good.

And if you have managed to stop for two months...

You may already have a physiotherapist, or you may not. Either way, after the operation it's a good idea to be guided through your rehabilitation by a physiotherapist experienced in hip and sports rehabilitation. You're allowed to start exercising straight after the operation, so make sure you schedule your first appointment with the therapist now. This can be within a few days, but certainly within the first week.

You'll receive the referral for the therapist straight after the operation. This will also state exactly what was seen and done, and what the instructions are for follow-up treatment.

There's a detailed guideline for the exercises you can do after the operation. You can download it here:

Most patients are allowed to fully weight-bear on the operated leg straight after a hip arthroscopy (please note: there are exceptions!). Even so, it's a good idea to have crutches to hand and use them for support after the operation. This lets you start off gently and get a feel for how things are going with pain, stability and balance. Depending on your pain levels, you can then either wean off the crutches a bit sooner or keep using them a bit longer. Your physiotherapist can guide you through this.

So make sure you have a pair of elbow crutches at home in good time.

You may already have these at home, but make sure you collect your prescribed medication from the pharmacy in good time. For the hip arthroscopy, this involves three medicines:

Also make sure you have enough paracetamol at home (500 mg tablets).

Are there certain medicines you're not allowed to have? If so, your specialist will have made separate arrangements about your medication with you. This usually concerns the medicine meloxicam. If you're not allowed to have this, omeprazole isn't needed either. For pain relief, paracetamol alone is usually enough in that case for most people.

Tomorrow's the day: your planned operation! One last check so you don't forget anything...

DON'T FORGET:

You must be fasting before the operation; read through the instructions for this carefully once more! This prevents unnecessary delay of the operation.

One last reminder: make sure you stick to the fasting policy!

During your stay, the anaesthetist is responsible for your pain relief. In practice, this means that after the operation you'll be given paracetamol and naproxen on the ward for pain relief; sometimes something stronger too. When you're discharged, you'll be given naproxen to take in the evening (together with paracetamol, which you should already have at home). So on the day of surgery you won't yet be using the meloxicam prescribed by your specialist — you'll only start that the following morning.

Also, don't use other painkillers such as ibuprofen, diclofenac or celecoxib. These painkillers all belong to the same category ('NSAIDs', anti-inflammatory pain relievers). Taking them alongside the naproxen would mean doubling up.

If you need more pain relief, the first step is usually to rest and find a comfortable position. That often works best. It can also help to do something else, such as listening to music or a podcast, or watching TV. Distraction also has an important pain-relieving effect. If all this isn't enough, you can contact the clinic (even outside office hours) and ask for extra pain relief. The next step is usually tramadol. Do keep in mind that stronger painkillers often have more side effects (such as drowsiness) and often only offer limited additional benefit in reducing pain.

Most people are allowed to fully weight-bear on the operated leg straight after a hip arthroscopy. This means you should be able to stand and walk without crutches. Even so, it's wise to first carefully 'test the water' and see how you're getting on. How's the pain? And your balance and stability? So use two crutches for support at the start.

There's one exception: if extensive cartilage damage was found during the operation, your specialist may advise you to only 'touch-weight-bear' for the first 6 weeks. This means you may rest your foot on the ground, but you must not put any weight on your leg. Your specialist will inform you about this, and the advice will also be included in the referral to the physiotherapist.

If your labrum was repaired during the operation, there's an additional piece of advice: be careful with deep bending of your hip! Bending up to 90 degrees is usually no problem. Deeper bending is allowed, but do it slowly and carefully. Try to avoid bringing your knee all the way to your chest during the first 6 weeks. And when you do bend your hip deeply, it's also wise not to turn your knee inwards at the same time. Your physiotherapist can guide you through this.

After the operation, you'll receive a referral for your physiotherapy. This also includes the full operation report, so the therapist knows exactly what was found, what was done, and what's been agreed for the correct follow-up treatment.

For two weeks, you need to have an injection every evening to reduce the risk of thrombosis. The nurse on the ward has given you instructions on how to give yourself this injection. So tonight is the first time. Then keep it up for 14 days; an injection every evening.

Below are the instructions again for giving the nadroparin injection.

Hopefully the first night went well. Time for your painkillers!

This morning you start with meloxicam (so no more naproxen). For the next two weeks, you need to take one 15 mg meloxicam tablet every morning. This works not only as a painkiller but also as an anti-inflammatory. It also helps prevent calcification around the joint. So even if you have little or no pain, the advice is still to use meloxicam for the first two weeks.

Although it isn't compulsory, it may be wise to use ordinary paracetamol today as well. Start with 2 tablets of 500 mg paracetamol, three times a day. This lets you start off carefully, and over the following days you can see whether, guided by your pain, you can start cutting down already, or whether you'd rather keep using paracetamol a bit longer.

As long as you're taking meloxicam in the morning, the advice is to take omeprazole at the same time. Omeprazole is a 40 mg tablet or capsule. You take this once a day, together with the meloxicam.

If your first day has gone well, you might be feeling like freshening up a bit. It's good to know that you're fine to shower. Just bear the following in mind:

Tonight is your last injection to prevent thrombosis!

After two weeks, the stitches can be removed. You can have this done at the clinic, but you can also do it yourself or have someone close to you do it; it's very straightforward! Here's how...

Up to now you've kept the dressings on the wounds. These can now be removed. There's a surface island dressing, and underneath it a few small adhesive wound strips. Take them all off! You'll now have 2 or 3 small scars, each with a loop and a knot at either end. Pull the loop with your fingers or a pair of tweezers, and use a small pair of (nail) scissors to cut the stitch below the knot, close to the skin. You can then pull the loop at the other end to remove the stitch completely.

If this doesn't work, don't worry. The stitches are dissolvable. Just cut off the other loop as well, and the rest of the stitch will dissolve by itself. Because the stitch sits in the skin, it can occasionally happen that your body 'pushes the stitch out'. You may then get a small scab on the scar, and when it falls off a thin thread may come away with it. That's not a problem, but you can prevent it by removing the stitch yourself.

After about 8 weeks, you'll come back to see your treating specialist. Before you see the specialist, an X-ray is sometimes taken first. This is only useful if something was done to the bone during the operation (cam or pincer) — a labrum can't be seen on an X-ray.

During the consultation, we'll talk about...:

Your scars will also be assessed and your hip will be examined.

It's normal at this stage to still have some symptoms, though this varies from person to person.

PLEASE NOTE: This is also the moment to ask questions. Think about this in advance and jot your questions down on your phone or a piece of paper so you don't forget anything.