Dr. Andrew B. Wolff — Preparing for Hip Arthroscopy

Thank you for trusting Dr. Wolff and the entire team at Wolff Orthopaedics for your care and recovery. We are committed to providing you the absolute best care throughout this process and will work on your behalf to make the process as smooth as possible for you.

Please review the following information and reach out to us through our Spruce portal.

For the complete surgery packet, you can download the full Wolff Orthopaedics Surgery Instructions PDF.

A Note from Dr. Wolff

Please read through this Surgery Packet and all documents given to you for your surgery, in their entirety. We understand that surgery is no small matter and are happy to discuss all questions you have, but please know that the answers to most questions can be found in the documents provided to you. We have specifically developed all surgery documents for hip arthroscopy and they are tailored with great detail to your procedure. Please take the time to read this information to ensure the best surgical experience and care.

Dr. Wolff performs 6-8 hip arthroscopies per week and this type of injury/surgery comprises the vast majority of his practice. We also want you to know that Dr. Wolff is out of network with all commercial insurances.

While every insurance company has its own policies regarding coverage for arthroscopic hip procedures, we have experience with nearly all of them. Our goal is to provide you with the best possible care in every aspect. Part of that is understanding and demystifying the billing process, which can be intimidating and scary. Please take the time to speak with our billing office about the particulars of your procedure as it relates to your specific insurance plan — these vary widely. We will advocate on your behalf to make this process less time-consuming and financially feasible.

Similarly, we will often ask for your help in this process to minimize your out-of-pocket expenses. Following surgery, Dr. Wolff’s billing staff may ask that you get involved in helping ensure coverage by your insurance company. You may be asked to draft a letter, make a phone call, or just be responsive with communications regarding paperwork and/or payments you receive from your insurance company. We ask that you are prepared and ready when we do reach out, as there are often tight timelines associated with the requests we may ask of you. The more helpful and responsive you are, the quicker this process will go.

Our office will do our best to be as responsive as possible should you have questions or concerns. We are all on the same team and look forward to working with you. Thank you for your understanding and patience through this process — our ultimate goal is to provide the best possible care to all of our patients.

For an explanation of the hip anatomy, labral tears, femoroacetabular impingement (FAI), and the specific procedures Dr. Wolff performs (including labral repair vs. reconstruction, osteoplasty, microfracture, and ligamentum teres reconstruction), see our Hips 101 page.

Expectations after Hip Arthroscopy

How long will it take to fully recover?

Dr. Wolff has very high success rates with hip arthroscopy. This success, however, depends a lot upon your cooperation during the recovery process.

He will optimize the mechanics of your hip through world class and cutting edge surgical techniques and procedures, but restoration of full function is largely dependent on you and your approach to the recovery period.

Be prepared to be patient. Minimize the stress and demands in your life during recovery to the extent possible.

The vast majority of Dr. Wolff’s surgical patients do not have a lot of pain from surgery itself and if they do, it generally subsides quickly. At that point, most of the pain that you will experience will be based upon your activity level.

We want to minimize pain to maximize your recovery.

Pain after hip surgery is generally a reflection of inflammation. Inflammation of your hip leads to dysfunction of the surrounding muscles. One commonality of an inflamed hip is that there is inhibition of the gluteus medius muscle. The Gluteus medius is the main stabilizer of your hip (and is also a key knee stabilizer). When your gluteus medius isn’t doing its job, other muscles that are ill-equipped to stabilze your hip overwork and then they themselves become a problem. Hence, the very common complaint of low back pain on the side of the painful hip, SI joint dysfunction, hip flexor trouble, piriformis pain, pelvic floor pain and dysfunction, etc..

The goal is to zero out your hip inflammation (pain) as efficiently as possible and gradually allow your activity level to climb up without return of the pain–until finally you can reach all of your goals pain-free!

For most patients, recovery is not linear. Pain level will correlate with activity level, which is why we stress “less is more.”

But don’t overthink it. Your hip is solid mechanically. If you do something that hurts, you’re probably not ready for that yet. If you don’t know what it was, it was likely a cumulative effect of what else you did that day or that week. So respond by doing less. This is why Dr. Wolff puts people on crutches for about a month outside of the house after surgery. It’s not that the hip will fall apart if you put weight on it, it’s more that crutches will allow you to do a bit more without overstressing and inflaming your hip.

Exact recovery time varies based on exact surgical procedures performed, but usually unrestricted physical activity will not be recommended for a minimum of 6 months. It is not uncommon to have “flare-ups,” or sporadic periods of increased pain for the first year. These are usually caused by over-activity and best treated with rest. Flare-ups do not mean that your surgery has failed.

How much pain will I be in after surgery?

Hip arthroscopy is different from other orthopedic procedures you may be more familiar with such as shoulder and knee surgery. In general, this procedure is less painful.

Most patients find that their discomfort is well tolerated after the first few days. That said, lack of pain can be misleading and makes it easy to overexert yourself.

While mobility is important, it should be limited in the first 6 weeks to get around the house and to and from necessary places (work, school etc). Post-op pain also tends to mimic pre-op pain to an extent, so don’t be discouraged by this.

Preparing to be Out of School and Work

Filing Short Term Disability

Do you have a short-term disability policy? Contact your short-term disability insurer to make sure all documentation requests are sent over to our office prior to surgery. Depending on your employer and job flexibility, we will create a tentative return to work program that makes sense for you. By filing early, this will help reduce any chance of disruption of pay or benefits.

FMLA (Family and Medical Leave Act)

The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons. Does your employer require you to file FMLA? Contact your HR department at work and see if your employer requires this before taking leave. If they do, make sure to contact our office so we can help file this for you.

When can I go back to work?

This depends on your specific duties at your job. For desk jobs, most patients can return after 1-2 weeks. Upon returning to work onsite, we recommend working part-time (4-6 hours) or fewer days for the first week or 2, then deciding to continue part-time or return full-time the following week depending on how you feel.

Oftentimes, commuting to and from the office is enough to increase pain/soreness and slow down recovery. If you can work from home, we recommend doing so if your employer will allow it. Sitting for prolonged periods will also increase discomfort. Be sure to change positions frequently. Most patients still find ice to be quite helpful even beyond the initial first weeks.

Physically demanding jobs will take months for full return, and we can work with you on a plan of action.

When can I go back to school?

Most students are back at school within a week (on crutches of course). Here are a few helpful tips:

  • Use the elevator, not the stairs
  • Wear comfortable and supportive shoes
  • DO NOT carry a heavy backpack
  • Avoid crowded hallways when you can
  • On a large campus, use available transportation and disability services to limit steps
  • Connect and communicate with instructors pre-operatively to see what course work or tests can be completed remotely or online

We can provide any letters needed to help with these accommodations. Please also note that you will not be cleared to participate in physical education for at least 3 months after surgery.

Things You May Not Have Thought of Before Surgery

Take inventory of your home! What do you think you will struggle with post-operatively? Where will you spend most of your time? While the items below are not required for recovery, many patients have found them to be useful, especially for the first several weeks.

  • Comfortable chair, couch or recliner
  • Grabbers
  • Long-handled shoehorn
  • Raised toilet seat
  • Shower chair
  • Body pillows (you should not sleep on your operative side for a while, so these can help provide some extra comfort and support!)
  • Storage bag to hook onto crutches (lots of options on Amazon!)
  • Leisure activities – good books, TV series, puzzles, crafts

You can find these products on Amazon. Use our mobile-friendly Linktree here for a shortcut: https://linktr.ee/AndrewWolffMD

Crutch Training

The length of time that you will need to use crutches will depend on your exact surgical procedure, but for most patients it is 4-6 weeks.

Prior to surgery, please click the link below and view the posted videos on how to properly use your crutches. This is a VERY important part of your recovery as using your crutches improperly can lead to increased hip pain.

It’s important to put weight on your operative leg. Crutch fitting and proper use will be reviewed at your first post-op appointment as well. If you already have a pair at home, try practicing!

View Crutch Training Videos

Adjusting your crutches:

  • Height should be just below your armpit. You should stand up straight when using the crutches, and weight should be placed primarily through your hands, NOT under your arms.
  • Elbows should be slightly bent at a 20-30 degree angle. Handles can be adjusted.

Handicap Parking

We will happily fill out and sign the application needed to obtain a handicap placard. You will need the application for the state in which your vehicle is registered. The DMV will provide you with a temporary placard.

Know Before You Go

  • Pre-op Clearance: Your medical intake forms will be reviewed, and you will be notified if you need to obtain pre-op clearance or testing. If clearance is needed, it must be completed with your primary care physician NO SOONER than 30 days prior to your date of surgery. EKGs are valid for 6 months prior to the date of surgery. Please make us aware of any current health issues and current medications, including cardiac issues, sleep apnea, bleeding/clotting disorders, diabetes, hypertension and high cholesterol.
  • Discontinue ALL NSAIDs and Aspirin 5 days prior to surgery. These include Ibuprofen, Aleve, Motrin, Naproxen, Celebrex, Meloxicam.
  • Do not eat or drink anything (including water) after midnight on the day of your surgery. You will be informed about which of your regular medications you should or should not take the day of surgery.
  • Surgery will be performed under general anesthesia. Medication will be given to you through an IV and you will be intubated once asleep. This can lead to a sore throat after surgery, which will resolve on its own. It’s important to stay well hydrated for optimal recovery in the days after surgery.
  • Dr. Wolff performs a local pain block around your hip at the beginning of surgery to help with post-op pain. This is different from a nerve block that you receive in your spine. You will have full use and feeling of your leg after surgery.
  • Crutches will be provided for you on the day of surgery. If you already have a pair, please bring them with you to surgery.

Your Medications and Coming Up with a Pain Plan

Many of our patients struggle with chronic pain pre-operatively which can sometimes interfere with their recovery.

NOTE: If you already have a pain management physician who is prescribing a controlled substance, we will defer to them for management and prescribing of pain medication post-op.

This link has been helping our patients understand both pre-operative and post-operative pain: Understanding Pain Video

Disclaimer: Please note that medications may be adjusted or substituted in accordance with individual health concerns or allergies. These will be prescribed for you prior to surgery so that you can have them filled and ready to go.

Physical Therapy

Should I be doing post-op exercises at home before I start PT?

It can be helpful to have someone at home perform passive range of motion exercises with you right after surgery. We recommend the passive range of motion exercises to be done twice a day for 4 weeks.

You will get them in with your physical therapist, so be sure to follow their lead on what to do at home. Please follow the link below for proper technique on passive range of motion with your partner: Passive Range of Motion Video

You will begin formal physical therapy as soon as 5-7 days after surgery. Your specific protocol will be given to you after surgery.

You may schedule with a physical therapist of your choice, but we have a list of preferred providers that we can provide. Please note, a lot of our preferred therapists are out of network. Depending on your plan and deductible, this doesn’t always mean more expensive.

Most patients have found that spending a little more, if it is feasible, on a highly skilled therapist endorsed by our team can make a world of difference in recovery. Having a good PT who is adherent to the protocol and who is attentive throughout sessions can have a lasting difference on rehab timelines and outcomes.

Pre-habilitation Exercises

In some cases, it may be helpful to begin some physical therapy exercises prior to surgery to optimize your post-op recovery. One of the goals of pre-hab is to allow patients to gain “muscle memory” and as you start to do these exercises post-operatively, you will find your body more familiar with them and possibly easier to do!

Please follow Dr. Wolff’s guidance on this. We suggest meeting with your physical therapist to review the following exercises so that you can begin doing them at home a few times per week before surgery.

You should NEVER continue with any exercise that is significantly increasing your pain or discomfort. Do not feel obligated to complete every exercise, as not every patient will be able to tolerate every exercise below and it will be dependent on level of pain and function. Exercises should not be performed every day as over-activity will only lead to increased pain. For strengthening exercises, 2-3 sets of 10 reps are sufficient.

Mental/Emotional Preparation

Mental and emotional preparation is one of the first steps a patient should take in planning for hip surgery. It is important to make sure that surgery and recovery fit into your busy life, minimizing outside distractions, travel, or big projects.

Feelings of anxiety, depression, and frustration are common, and it is important to stay positive leading up to and throughout your recovery. Make sure your support system is established between family and friends.

Remember to be aware of all aspects of your recovery without being fixated on an end result. No two patients have the exact same recovery timeline or experience. Let our team be a resource for you and remember to communicate your concerns.

An outside resource you can explore is from a company called The Unbroken Athlete. It is a structured online roadmap for rebuilding confidence, strength, and resilience. While the theme is geared toward athletes, it connects to most every patient’s path to recovery. You can use code DRWOLFF for a discount at checkout.