Hip Synovectomy: A Complete Guide for Patients

Introduction to Hip Synovectomy

Hip pain and inflammation can severely impact mobility and quality of life. When conservative treatments fail, a hip synovectomy may be recommended. This surgical procedure involves removing inflamed synovial tissue—the lining of the hip joint—to relieve pain, reduce swelling, and prevent further joint damage.

Commonly performed for conditions like rheumatoid arthritis, juvenile idiopathic arthritis, or pigmented villonodular synovitis (PVNS), hip synovectomy helps restore joint function. Advances in minimally invasive techniques (arthroscopic synovectomy) have made recovery faster and safer.

In this guide, we’ll explore what hip synovectomy entails, who needs it, the surgical process, recovery tips, and potential risks—helping you make an informed decision about your treatment.

What is Hip Synovectomy? (Definition & Purpose)

A hip synovectomy is a surgical procedure where the inflamed synovium (joint lining) is partially or completely removed. The synovium produces fluid that lubricates joints, but when diseased (e.g., due to arthritis), it thickens, causing pain, stiffness, and cartilage damage.

The primary goals of this surgery are:

• Pain Relief: Removing inflamed tissue reduces chronic hip pain.
• Improved Mobility: Restores smoother joint movement.
• Preventing Joint Damage: Stops synovial overgrowth from eroding cartilage or bone.

Hip synovectomy is often considered when medications, physical therapy, or injections no longer work. It can be performed as an open surgery (larger incision) or arthroscopically (minimally invasive).

Conditions That Require Hip Synovectomy

Not all hip pain requires synovectomy. It’s typically recommended for specific inflammatory or degenerative conditions, including:

• Rheumatoid Arthritis (RA): Autoimmune disease causing synovial inflammation.
• Juvenile Idiopathic Arthritis (JIA): Affects children, leading to chronic joint swelling.
• Pigmented Villonodular Synovitis (PVNS): A rare, benign tumor-like synovial overgrowth.
• Septic Arthritis: Infection-induced synovitis unresponsive to antibiotics.
• Hemophilic Arthropathy: Bleeding disorders causing joint damage.

Early intervention can prevent irreversible joint damage. Your doctor may recommend synovectomy if imaging (MRI/X-rays) shows synovial thickening or if symptoms persist despite 3–6 months of non-surgical treatments.

Types of Hip Synovectomy (Open vs. Arthroscopic)

Hip synovectomy can be performed via two main techniques:

1. Open Synovectomy

Involves a larger incision (5–10 cm) to directly access the hip joint. Best for:

• Extensive synovial overgrowth (e.g., PVNS).
• Cases requiring additional repairs (e.g., bone grafts).

Pros: Complete synovium removal. Cons: Longer recovery, higher infection risk.

2. Arthroscopic Synovectomy

Uses 2–3 small incisions (<1 cm) and a camera-guided scope. Ideal for:

• Localized synovitis.
• Patients seeking faster recovery.

Pros: Less pain, minimal scarring. Cons: Not suitable for severe cases.

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

Preparing for Hip Synovectomy Surgery

Proper preparation ensures a smoother surgery and recovery. Key steps include:

• Medical Evaluation: Blood tests, imaging (MRI/X-ray), and cardiac clearance if needed.
• Medication Adjustments: Stop blood thinners (e.g., aspirin) 1–2 weeks prior.
• Prehab (Pre-surgery PT): Strengthen hip muscles to aid recovery.
• Home Setup: Arrange a recovery space (e.g., raised toilet seat, ice packs).

Day Before Surgery: Fast after midnight; shower with antiseptic soap. Bring loose clothing and a companion to drive you home.

Discuss anesthesia options (general or spinal) with your surgeon. Most arthroscopic procedures are outpatient, while open synovectomy may require a 1–2-day hospital stay.

Step-by-Step Procedure of Hip Synovectomy

Here’s what to expect during the surgery:

1. Anesthesia: Administered to ensure no pain (general or spinal).
2. Incision(s):
   • Arthroscopic: 2–3 tiny cuts for the scope and instruments.
   • Open: Single larger incision.
3. Synovium Removal: Inflamed tissue is carefully excised.
4. Joint Inspection: Surgeon checks for additional damage (e.g., cartilage wear).
5. Closure: Incisions stitched; sterile dressing applied.

The surgery takes 1–3 hours, depending on complexity. Arthroscopic patients often go home the same day.

Recovery & Rehabilitation After Surgery

Recovery varies by procedure type:

• First 48 Hours: Rest, ice, and pain meds. Use crutches/walker if needed.
• 1–2 Weeks: Staples/stitches removed; gentle hip exercises begin.
• 6–12 Weeks: Physical therapy to restore strength and range of motion.

Tips for Faster Healing:

• Avoid high-impact activities (running) for 3–6 months.
• Attend all PT sessions to prevent stiffness.
• Eat protein-rich foods to aid tissue repair.

Most patients resume light work within 2–4 weeks (arthroscopic) or 6–8 weeks (open).

Risks & Complications of Hip Synovectomy

While generally safe, potential risks include:

• Infection: Rare but requires antibiotics.
• Blood Clots: Prevent with compression stockings/medications.
• Nerve Damage: Temporary numbness near incisions.
• Recurrence: Synovitis may return in aggressive cases (e.g., PVNS).

When to Call Your Doctor:

• Fever >101°F or pus at incision site (infection signs).
• Severe swelling/unrelenting pain.

Choosing an experienced surgeon minimizes these risks.

FAQs About Hip Synovectomy