Hip Synovectomy: A Complete Guide to the Procedure

Introduction to Hip Synovectomy

Hip pain and stiffness can severely impact mobility, especially when caused by chronic inflammation of the synovial membrane—a thin tissue lining the joint. A hip synovectomy is a surgical procedure designed to remove this inflamed tissue, offering relief and restoring function. Whether due to arthritis, infection, or autoimmune conditions like rheumatoid arthritis, this surgery can be a game-changer for patients unresponsive to conservative treatments.

In this guide, we’ll explore what a hip synovectomy entails, who needs it, the different surgical approaches, and what to expect during recovery. By the end, you’ll have a clear understanding of how this procedure works and whether it might be the right solution for your hip issues.

What is Hip Synovectomy? (Definition & Purpose)

A hip synovectomy is a surgical procedure where the inflamed or damaged synovial membrane (the soft tissue lining the hip joint) is partially or completely removed. The synovium produces fluid that lubricates the joint, but when diseased, it can cause pain, swelling, and cartilage damage.

The primary goals of this surgery are:

• Reduce pain caused by chronic inflammation.
• Prevent further joint damage by stopping synovial overgrowth.
• Improve mobility by removing restrictive tissue.

This procedure is often recommended when medications, physical therapy, or injections fail to provide relief. It’s commonly used for conditions like rheumatoid arthritis, pigmented villonodular synovitis (PVNS), or infectious synovitis.

Conditions That Require Hip Synovectomy

Not all hip pain requires a synovectomy. This surgery is typically reserved for specific conditions where the synovium becomes abnormally thickened or inflamed, leading to persistent symptoms. Key conditions include:

• Rheumatoid Arthritis (RA): An autoimmune disease where the synovium becomes inflamed, eroding cartilage and bone.
• Pigmented Villonodular Synovitis (PVNS): A rare, benign tumor-like condition causing synovial overgrowth.
• Septic Arthritis: A bacterial or fungal infection in the joint requiring synovial removal to prevent spread.
• Osteoarthritis (Advanced Cases): In some cases, synovitis accompanies severe arthritis.
• Hemophilic Arthropathy: Repeated bleeding into the joint in hemophilia patients damages the synovium.

If conservative treatments (NSAIDs, steroid injections, or physical therapy) don’t work, your doctor may recommend a synovectomy to halt disease progression.

Types of Hip Synovectomy (Arthroscopic vs. Open Surgery)

Hip synovectomy can be performed using two main techniques, each with its own advantages:

1. Arthroscopic Hip Synovectomy

This minimally invasive approach uses small incisions and a camera (arthroscope) to guide the surgeon. Benefits include:

• Faster recovery
• Less post-op pain
• Lower infection risk

2. Open Hip Synovectomy

In complex cases, a larger incision may be needed for direct access. This is often used for:

• Extensive synovial disease (e.g., PVNS)
• When joint reconstruction is also required

Your surgeon will choose the best method based on your condition’s severity and overall health.

Preparing for Hip Synovectomy Surgery

Proper preparation ensures a smoother surgery and recovery. Here’s what to expect:

• Medical Evaluation: Blood tests, imaging (MRI/X-rays), and a physical exam to assess joint damage.
• Medication Adjustments: Stopping blood thinners or NSAIDs before surgery.
• Prehab (Pre-Surgery PT): Strengthening the hip muscles can aid recovery.
• Fasting: No food or drink 8–12 hours before the procedure.
• Arranging Support: You’ll need help with mobility for the first few days post-op.

Discuss all medications and allergies with your surgeon to avoid complications.

Step-by-Step Procedure of Hip Synovectomy

Here’s what happens during a typical arthroscopic hip synovectomy:

1. Anesthesia: General or spinal anesthesia is administered.
2. Incision: 2–3 small cuts (0.5 cm) are made around the hip.
3. Arthroscope Insertion: A camera projects the joint onto a screen.
4. Debridement: Inflamed synovium is removed with tiny instruments.
5. Irrigation & Closure: The joint is flushed, and incisions are stitched.

The surgery takes 1–2 hours, and most patients go home the same day.

Recovery & Rehabilitation After Surgery

Recovery varies by procedure type, but general guidelines include:

• First 48 Hours: Rest, ice, and pain management.
• 1–2 Weeks: Crutches or a walker may be needed.
• Physical Therapy: Starts within 1–2 weeks to restore strength and flexibility.
• 6–12 Weeks: Gradual return to normal activities.

Full recovery can take 3–6 months, depending on pre-surgery joint damage.

Risks & Complications of Hip Synovectomy

While generally safe, potential risks include:

• Infection: Rare but possible, requiring antibiotics.
• Blood Clots: Prevented with compression stockings or blood thinners.
• Nerve Damage: Temporary numbness near incisions.
• Recurrence: Inflammatory conditions may regrow synovium.

Choosing an experienced surgeon minimizes these risks.

FAQs About Hip Synovectomy