Surgery for Frozen Hip

The goals of surgery for frozen hip are to reduce hip pain, improve joint mobility, and improve overall quality of life.

Surgery for frozen hip or adhesive capsulitis of the hip is rare and considered when non-surgical interventions have been tried for at least 1 year or more, and fail to provide adequate pain relief and improve mobility.

When Surgery May Be Considered for Frozen Hip

Surgical procedures are typically reserved for cases where:

• Hip pain and/or stiffness is severe or progressive even after several combinations of non-surgical treatments have been tried
• There are significant limitations in daily activities due to restricted hip mobility
• Co-occurring hip joint issues, such as hip labral tears or hip impingement, have been identified through diagnostic tests

The long-term outcomes and success rates of surgery for frozen hip are not established in literature.¹de Sa D, Phillips M, Catapano M, et al. Adhesive capsulitis of the hip: a review addressing diagnosis, treatment and outcomes. J Hip Preserv Surg. 2015;3(1):43-55. Published 2015 Nov 27. doi:10.1093/jhps/hnv075

Minimally Invasive Surgery for Frozen Hip

Most surgical options for frozen hip are minimally invasive and use a tool called an arthroscope.

Here's a breakdown of the typical process:

• Anesthesia: General anesthesia is often used to ensure complete relaxation and pain control. In some cases, local anesthesia may be given, depending on the specific procedure, surgeon’s preference, and patient factors.
• Incisions: The surgeon makes 2 to 3 small incisions (about 5 mm long)  around the hip joint.
• Arthroscope insertion: A thin tube-like instrument called an arthroscope is inserted through one of the incisions. The arthroscope contains a miniature camera and light source, and the surgeon sees the image on a computer monitor. The visualization includes the inside of the hip joint, hip capsule, synovial membrane, joint cartilage, hip labrum (a ring of soft tissue surrounding the hip socket), and other structures.
• Surgical instruments insertion: Small instruments are inserted through the other incisions to perform the necessary procedures, such as:
  • Removing damaged tissue such as scar tissue, frayed cartilage, or inflamed synovium (the lining of the hip capsule)
  • Repairing torn ligaments or the labrum using sutures or anchors
  • Trimming excess bone or cartilage causing hip impingement
• Instrument removal: Once the procedure is complete, the arthroscope and surgical instruments are removed.
• Incision closure: The incisions are stitched or stapled.

Common arthroscopic procedures for frozen hip are:

• Adhesiolysis: Removal of scar tissue
• Synovectomy: Removal of the inflamed synovial membrane
• Capsulectomy: Release of tight portions of the hip joint capsule

Depending on the anatomical problems causing the hip joint to lock up, one or more of the above procedures may be performed.

Recovery after hip arthroscopic surgery

For most individuals, arthroscopic surgery is performed on an outpatient basis, meaning the patient returns home the same day. Older individuals or anyone with co-occurring medical conditions may require a hospital stay of 1-2 days.

Following arthroscopic surgery, physical therapy is recommended for regaining strength, flexibility, and full range of motion in the hip.

Recovery takes several months, and a gradual return to activities is advised to avoid complications.

There is limited research evaluating the success of arthroscopic surgery for frozen hip.

Hip Joint Replacement Surgery

In rare cases, when all other treatment options have been exhausted and the hip joint is severely damaged by arthritis or other complications associated with frozen hip, a total hip replacement surgery may be recommended. This procedure involves replacing the damaged hip joint with an artificial hip.

Open and minimally invasive approaches

Hip joint replacement may be performed:

• As an open procedure (traditional method) using one large incision
• Through minimally invasive methods using one or two small incisions

The type of approach used depends on the anatomy of the patient’s hip joint, the type of implant used, and the patient’s individual factors, such as age and the condition of the hip bones.

Read more about Total Hip Replacement on Arthritis-health.com

Recovery after hip joint replacement

Hip replacement is a major surgery, and most individuals require a hospital stay of 1-2 days following surgery. Patients are instructed to avoid extreme range of motion and weight bearing in the new hip joint for several weeks after hip replacement.

Rehabilitation following hip replacement is essential for regaining strength, flexibility, and a normal gait pattern. Most patients experience a significant improvement in their quality of life after hip replacement surgery.

Read more about Total Hip Replacement Surgery Recovery on Arthritis-health.com