​​​​Hip Arthroscopy

Prior to starting the procedure, the patient is placed on a traction table. There is a well-padded post in between the legs and the legs are in a ski boot type device, which allows us to pull on the leg whilst maintaining your body in the same position (traction). This creates room to place the camera through an incision into the hip joint. Through the second incision the instruments are placed, sometimes a third incision is needed. And x-ray machine is used throughout the procedure to confirm correct placement of instruments and adequate excision/trimming of bone.

​actual video of the excess bone being trimmed

The operation can take anything from 1.5 to 3 hours and depends on how much work needs to be done in the hip joint. The surgical scars are small, however there may be considerable swelling after the procedure as a lot of fluid is run through the hip joint and some of this can be absorbed in the skin and muscle. Rest assured, over the course of the next two weeks this all subsides.

Hospital stay

I usually perform the hip arthroscopy as a day procedure. This means that the surgery occurs in the morning and patients go home later on that afternoon or evening. Occasionally patients may need to stay in overnight if pain control is an issue. Most patients walk with the aid of crutches but I allow them to put all their weight on the leg. Very rarely do I need to restrict the amount of weight placed through the leg. Most patients use one or two crutches for a week or two. The minimum period I advise my patients to be off work is two weeks. Depending on how you commute to work this may increase to 6 weeks.

Rehabilitation

The key to success following surgery is rehabilitation. Frequently, I ask my patients to see a good physiotherapist with a “pre-habilitation” program. This is to condition the muscles so that they are at their optimum prior to surgery. Following surgery, rehabilitation protocols are essential. My patients do pendulum exercises on the same day of surgery. If possible, the use of a static bike from the next day is very useful to prevent stiffness and maintain range of motion. Supervised physiotherapy is then undertaken and the rehabilitation is a commitment. After the intial phase of stretching and strengthening, patients progress to stamina and sports specific rehab. We can discuss this in detail if we decide this is the correct operation for you. It can take 4-6 months to fully recover from this procedure.

Why do we perform hip arthroscopy?

There are three main reasons why I perform hip arthroscopy.

​​​​Femoroacetabular impingement (FAI) (or Hip Impingement)

There are two main types of hip impingement. In cam hip impingement there is excess bone around the ball of your femur. In pincer hip impingement the socket is overgrown and covers more of the ball. In mixed impingement, both abnormalities exist. In all forms of impingement, patients complain of groin pain when they flex their hips (bring their knee towards the chest). During arthroscopy the excess bone can be shaved thereby allowing smoother movement. I typically perform a dynamic test for residual impingement to ensure I have taken away adequate bone.

​Cam Hip impingement

​Pincer hip impingement

​Mixed hip impingement

Labral tear

The rim of your hip socket is lined with a fibrous cartilage called the labrum. This cartilage is different to the cartilage lining the ball and socket of the hip joint. The labrum serves to keep the fluid inside the hip joint and forms a suction seal. For further information please read my article on ‘your hips don’t lie’.

The labrum can be torn for a variety of reasons. The most common reason is hip impingement. Patients are also prone to labral tears if they have dysplasia of the hip where the socket is not fully developed and doesn’t cover all of the femoral head or ball. The labrum can also be torn in sporting injuries. During hip arthroscopy, I always aim to preserve the labrum and repair if possible. The results have been shown to be better with a repair than the more commonly performed debridement.

Click here to learn more about labral tears

Articular cartilage damage

The cartilage lining the ball and socket of your hip joint is truly a unique structure that nature has provided us with. It’s facilitates smooth movement of the joint that is fiction free. This cartilage can be torn as a result of hip impingement or simply just trauma from activities that involve running or jumping or pivoting. A number of techniques can be used to address this during hip arthroscopy.

Complications and surgical risks

All surgery carries risks, which can be generalised or specific to the surgery. General complications include things related to the general anaesthesia, for example, inability to pass urine , blood clots in the legs or lungs, and infection can occur with any surgical procedure, but is extremely low following hip arthroscopy.

Specific risks to hip arthroscopy include

  • nerve damage, causing numbness on the side of your thigh
  • traction injury, causing numbness and bruising in the groin and a foot
  • very rarely, damage to the sciatic nerve leading to foot drop
  • rarely, the labrum repair fails to heal or gets retorn again
  • Sometimes, fibrous bands or adhesions can form in the joint leading to stiffness

​We can discuss all of these during our consultation and there will be plenty of time to discuss everything in more detail.

​Why choose Mr. Jaiswal?

Not only have I completed a fellowship in a high volume hip arthroscopy centre, but also, I have been a consultant in a highly specialised Young Adult Hip Unit. During this time, I was selected by the British Hip Society to undertake the prestigious Travelling Fellowship in Vail, Colorado (USA) to learn from one of the best hip arthroscopists in the world (Marc Philippon). Thus, you should be reassured, that I have learnt and practice on a regular basis advanced hip arthroscopy techniques to achieve the best possible outcomes for my patients. Currently, I am in the process of setting up a Young Adult Hip Unit at The Royal Free London NHS Trust.

Frequently Asked Questions

How long does hip arthroscopy take?

The surgery usually takes about an hour and a half to perform. If there is more extensive work required it can take up to 2 1/2 hours. I ensure that the labrum is very stable after I have repaired it and the duration of surgery is longer, if more stitches are required to stabilise it.​

How long do I need to stay in hospital?

​I usually perform the procedure as a day case. The operation usually occurs in the morning and patients go home the afternoon or evening. Occasionally and especially if patients live far away they may stay overnight. Patients get seen by the physiotherapist in the morning of surgery and before discharge.

What problems are issues can I expect after the surgery

​There will be considerable swelling around the hip. The swelling should subside over the next 2 to 3 weeks. There may also be some bruising and certainly you will experience some discomfort. There may be some numbness around the groin thigh or foot area and the ankle may be sore. There may be some leakage from the wounds and if this persists for more than 2 to 3 days then you should contact my practice.

You will require two crutches and usually patients have them for a week and then one crutch for the second week. Depending on how I have repaired the labrum, your hip movements may be restricted to 90°. You’ll be encouraged to use a static bike from day one to get the hip moving and prevent stiffness. Pendulum exercises should be performed from the evening of the surgery and the physiotherapist will show you what to do and how to do it.

Can I shower with my dressings on?

You will be discharged with waterproof dressings and therefore you will be allowed to shower. We will give you spare dressings in case the ones that were put on after surgery come off.

When can I drive after surgery?

​I usually allow patients to drive after two weeks and when the wounds have healed. You will need to make an assessment of how comfortable you feel in the car. The key factor is the ability to perform an emergency stop and this will need to be tested before going on the road.

When will I need a follow-up appointment?

​The stitches will need to come out at two weeks and this is usually done at your general practice by a nurse. I usually like to see my patients six weeks after the operation but this can be changed to a time which is more convenient for you.

When can I travel after surgery?

You can travel when you feel comfortable. For long-distance travel, I advise patients to wait at least six weeks and if possible 12 weeks. This lowers the risk of getting blood clots.

​Testimonials

What they say

“Fully recommend Mr. Jaisawal”

I first met Dr Jaiswal at Guy’s hospital in March 2017 & from our first encounter he was pleasant & immediately likable. He gave me the opportunity to fully explain exactly what issues I had & how they were affecting my daily life, he was very sympathetic, patient & I felt that he could empathise with me. He then used charts & diagrams etc to explain to me exactly what was causing my condition & how it could be repaired, what the pros & cons were, also the success rate for the procedure. He gave me enough information to make an informed decision to go ahead with surgery asap. The surgery carried out was a right hip arthroscopy & repair to labral tear, since surgery all the pain I had previously endured has totally gone & my recovery has been very good so far. I commend & fully recommend Dr Jaiswal, may I take this opportunity to thank you & all the staff who gave me excellent care during my short stay at Guy’s.

“Attentive and understanding at all times”

I have been massively impressed with Mr Jaiswal throughout my treatment (I first saw him in Feb 17). Attentive and understanding at all times; he explained things extremely clearly, outlined my options and I always felt that the patient came first. I was particularly impressed with the amount of time he gave all his patients during ward rounds (he seemed to visit more often than other consultants). My surgery was, apparently, not straight forward but I have made a good recovery and I am delighted with the treatment I have received. I can not recommend Mr Jaiswal highly enough.

“So glad I saw Mr. Jaiswal”

Mr Jaiswal has a great manner and talks to you with respect and compassion. I had wanted to see a colleague of his who specialised in my hip condition. His waiting list was over 9 months so I was referred to Mr Jaiswal instead. I am so glad. He immediately recognised my problem after 5 years of it being missed or ignored by other NHS professionals. He performed a total hip replacement under local anaesthetic and within hours I was able to use the toilet (no bedpan!) and go home the next day. He did a great job and 7 weeks later I am able to walk, stand up straight and get out of a sitting position without pain or restriction

“An excellent surgeon”

Mr Jaiswal is an excellent surgeon. The competency & dedication of him and his team was exemplary when I suffered an injury in December. As a trainee doctor, it is inspiring to see how a caring attitude together with excellent clinical practice directly results in the best clinical outcomes. I am sure, the fact that I am almost ready to consider running again after breaking my hip less than four months ago, is due to the fantastic care I received whilst an inpatient and continue to receive during follow-up.

“Eternally grateful to Mr. Jaiswal”

My husband and I are eternally grateful to Mr Jaiswal for the care he took in replacing both of my hips in two separate surgical procedures over two years. I can now walk painfree and can go on to enjoy our retirement as we would wish. I would not hesitate in recommending him as an excellent orthopaedic surgeon who is technically competent, very professional in manner and someone who gives you close personal attention even when he has a waiting room brimming with patients. He was patient in answering all our concerns, he addressed the risks and limitations of the new joint, he explained in detail everything that the surgery would entail and how the recovery process might unfold. Mr Jaiswal turned my traumatic procedure into an everyday experience tossed in with humour. Now that both of my hips have been “done”, we shall miss him and wish him every success in his career going forward.

I admire Mr. Jaiswal greatly as a surgeon and as a person”

When I first met Mr Jaiswal in the outpatients department at Guys he heard that I had been dieting and had lost 2 stone in weight. He got up from his chair and came over to me to shake my hand and congratulate me. He was extremely courteous. He discussed the operation with me taking time to talk to me and explained everything in simple English that I was able to understand. When I arrived in the operating theatre I could see Mr Jaiswal talking to his team in a relaxed friendly way and this helped a great deal to give me confidence. At my post op assessment Mr Jaiswal was very caring. My operation as been a great success and I admire Mr Jaiswal greatly as a surgeon and as a person.

“I cannot praise this surgeon enough”

I cannot praise this surgeon enough, I have suffered for many years with arthritic hips and at the age of 44, classed as a “young patient” I was very nervous that this was the right option for me but Mr Jaiswal was/is a fantastic man ! From the very first time I saw him and my issues were discussed, I knew that I was in the best hands possible. All aspects of the operation were explained to me so I was made to feel like I mattered. Mr Jaiswal was also very considerate when carrying out the operation, taking great care to preserve a memorial tattoo I have of my Mum. I was “awake” for the op and I would definitely recommend it – what an experience, I also feel that my recovery time has been quicker – I went in on the Thursday afternoon and was home on the Saturday afternoon. Amazing care on Sarah ward too.

“Mr. Jaiswal is delightful and approachable”

I had a total hip replacement just over a year ago and have just been discharged. Since I had the operation, progress has been swift and recovery total. It was a complete success. I cannot fault the after care which was regular and thorough. I was in hospital after the operation for just 3 days. During that time the staff were helpful and friendly. Mr Jaiswal himself is delightful and approachable, answering any questions that one may want to ask; and he is obviously a highly skilled surgeon. I had complete trust.

“Significant improvement”

After nearly two years of struggling to find a diagnosis for my pain at a different hospital, I was finally referred to Mr Jaiswal at Guys,who very quickly organised a range of scans, found a diagnosis and arranged hip arthroscopy and labral repair. 3 months later and I already have a significant improvement in the movement in my hip and the pain has drastically reduced.

“I would recommend him completely”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“Our family cannot thank Mr. Jaiswal enough”

Mr. Jaiswal operated on my father , prior to this every other surgeon that had seen him back so many words said that his condition was inoperable. Until that is he was seen by Mr. Jaiswal. I cannot thank this man enough. After completing an extremely complex surgery on my father he now is not in any pain and actually has an extremely good chance of being able to walk with a walking stuck and not crutches. Our family cannot thank Mr. Jaiswal and his team at the Royal Free enough.

A. Ward

“I cannot speak highly enough of the care I received from Mr. Jaiswal”

Dr. Parag Jaiswal is without doubt a first class Orthopaedic surgeon. I have been “under” him on two occasions and with each procedure he was caring, re-assuring and very understanding to his patients needs and would always listen to his patients. The total hip replacement he gave me in November was perfect in every detail. The speed of my recovery has also been enhanced by Mr. Jaiswal’s technique of making the smallest incision, a scar of about 6 inches, to perform the procedure and therefore healing time and discomfort have been kept to a minimum. Not only has he given me back a painfree life, I can now start attending events, social gatherings and family parties without the worry or stress of being in pain and discomfort. Dr. Jaiswal opted for the best prosthetic to suit bot my life style and job role (printroom manager) which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal, fellow Doctors, nurses and all the background staff at Guy’s hospital. Without doubt this great NHS is full of wonderful caring people like Mr Jaiswal and his team. Thank you for giving back my life.

 

Anthony Chaplin

“I cannot recommend him highly enough”

Mr Jaiswal operated on my leg following a fall, he was extremely kind and gentle. He explained step by step everything I needed to know, which not all surgeons will do. I found him very professional and he had a very good bedside manner. I was very anxious about being able to walk in the future, he reassured me through explaining all details. I felt he really cared, and my future rehabilitation mattered to him personally. Anybody that needs an orthopaedic operation would be very lucky to have him. I can not recommend him highly enough.

L. Blackman

“Mr. Jaiswal did a superb job”

I saw Mr Jaiswal for a full hip replacement when in great pain. He was sympathetic in the initial consultation and went to trouble to explain the procedure, discuss the hip replacement and out me at ease. I opted for general anaesthetic and suffered no poor consequences on the first day I was up and walking with crutches. People had warned me to expect a long have recovery but I was off the crutches inside 2 weeks and walking to my local village an back with shopping in a back pack, no crutches no pain from my hip. Of course there was some pain from the operation but that soon went. I was climbing stair again straight away on return home of course slowly at first but no crutches. The physiotherapist said my recovery was remarkable but I am confident it is because Mr Jaiswal did a superb job leaving me the easy part of getting on my feet. I plan to return to tennis now. Whilst I can only give my personal experience I happily recommend Mr Jaiswal and consider myself fortunate to have had his services.

“The most amazing work”

One year from having total hip replacement well I’ve had no pain from my hip. I can do single leg pistol squats also I’ve climbed stairs for half an hour with ease. The best test I’ve done for my hip was going snowboard and had no problems with it. Dr. Paraj Jaiswal done the most amazing work on me he even cut into my hip which he done around my tattoo you can hardly see the scar. I thank him and his team for what I consider was the best job they could have done as I also can walk correctly now once again big thanks to all.

Jason Hinton

“Very glad to have been treated by Mr. Jaiswal”

My 24 year old artificial hip snapped and Mr Jaiswal was very enthusiastic about redoing the hip. He actually tweeted the xray with my permission and I noted that it was commented on by a Professor of Orthopaedics at Harvard!. He explained to me {and both my daughters individually!} the whole procedure outlining the possible difficulties and risks. He was very patient about this and I felt informed and confident that I was in very good hands. I did have to wait nearly a week for the operation but that was partly because the hospital was particularly busy and also because specialist equipment had to be acquired. In the event the operation was relatively straight forward. It did not take as long as it might have done if he had had to break the femur to remove parts of the old prosthesis. It did involve a bone donation. I did not need a period in the ICU where a place had been reserved. I made a speedy recovery with the help of the hospital physios and was glad to be sent to a rehab unit for a couple of weeks. I had several conversations before and after the operation with Mr Jaiswal and other members of the team. All were positive. Mr Jaiswal also rang me this week to enquire about my progress during the lockdown and we discussed exercises and the problem of my other hip. He was constructive and made several suggestions. I hope to have a follow up appointment after lockdown I am very glad to have been treated by Mr. Jaiswal and his team and I feel confident he will help with any future orthopaedic problems I have. I hope he stays at the Royal Free!

Irene Woodworth

“Delighted in the outcome of surgery”

I required total hip replacement after longstanding distortion to pelvis from an accident. The op enabled early mobility and discharge less than 48 hours afterwards. Mr Jaiswal understood my ambition to return to sport and corrected unequal leg length, also arranged for long physio programme which enabled an early return. A feature of his care was his obvious delight in both the outcome of the surgery and my success in resuming my sport.

“Fantastic job”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“First class orthopaedic surgeon”

Dr. Parag Jaiswal is first class Orthopaedic surgeon. The total hip replacement he gave me is perfect in every detail. The speed of my recovery has also been enhanced by Mr. Parags’ technique of making the smallest incission to perform the the proceedure and therefore healing time and discomfort have been kepto a minimum.. My occupation as a full time Firefighter can now continue and with this in mind Dr. Jaiswal opted for the best prosthetic to suit my life style which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal and all the staff Doctors and nurses at Guy’s hospital. Thank you.

R.J. Cummings

You DON'T Have to put up with the

Pain & Stiffness.

Get Seen by an Expert Without Delay.