Hip Arthroscopy
Hip arthroscopy is a closed surgical technique used in conditions such as femoroacetabular impingement (FAI), tears of the joint rim (labrum) and loose bodies within the joint. Because the hip is a deeply placed joint, the procedure is carried out on a specialised traction table under imaging guidance.
The Structure of the Hip Joint
The hip is a deep and stable ball-and-socket joint formed by the head of the thigh bone sitting in the socket (acetabulum) of the pelvis. The labrum, a cartilage rim surrounding the edge of the socket, both deepens the joint and distributes load by maintaining the fluid pressure inside it. This deep position makes hip problems harder to diagnose than those of other joints.
In Which Conditions Is It Considered?
- Femoroacetabular impingement (FAI) — where excess bone at the head–neck junction of the thigh bone (cam type) or at the socket rim (pincer type) causes impingement during movement
- Labral tears — repair or reshaping
- Removal of loose bodies within the joint
- Assessment and treatment of cartilage lesions
- Injuries of the ligamentum teres
- Snapping hip syndrome related to the iliopsoas tendon
- Resistant synovitis and problems of the joint lining
- Assessment of certain intra-articular problems arising after hip replacement
How Do Symptoms Present?
Pain arising from the hip joint is most often felt in the groin; patients frequently describe it by placing the hand in a “C” shape over the side of the hip (the C sign). Sitting for long periods, getting in and out of a car, squatting, tying shoelaces or rotating the leg inwards may aggravate the symptoms. Some patients also report catching, locking or a sense of giving way.
Hip pain can be confused with lumbar disc herniation, inguinal hernia, hip osteoarthritis and problems of the surrounding tendons. Differential diagnosis is therefore important.
Diagnosis and Assessment
- History: the site of pain, which movements aggravate it, sporting and occupational load, any history of injury.
- Physical examination: range of movement, impingement tests, strength of surrounding muscles and gait assessment.
- X-ray: bone structure, joint space and bone shape variations that may cause impingement.
- MRI / MR arthrography: assessment of the labrum, cartilage and soft tissues.
- Diagnostic injection: in selected cases this may be used to establish whether the pain truly arises from within the joint.
Conservative Treatment First
The decision to perform hip arthroscopy is not taken hastily. Activity modification, avoidance of movements that cause impingement, a physiotherapy programme targeting the hip and trunk muscles, and pain management are applied first. In cases where marked osteoarthritis has developed, the expected benefit from arthroscopy is reduced; different treatment options are then considered.
How Is the Procedure Performed?
Because the hip is a deep joint, the joint space needs to be opened slightly during the procedure; this is generally achieved with a specialised traction table under imaging guidance. The camera and instruments are introduced through a few small portals. Depending on the problem identified, labral repair, correction of excess bone (osteoplasty), cartilage treatment or removal of loose bodies may be carried out.
Hip arthroscopy is a technically demanding procedure with a distinct learning curve, and appropriate patient selection directly affects the outcome.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
In the early period, partial weight-bearing with crutches, avoidance of certain movements and controlled early range-of-movement work come to the fore. The rehabilitation programme is planned according to the procedure performed (repair or reshaping) and the accompanying condition of the cartilage. The length of the process varies from person to person.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Temporary numbness or altered sensation related to traction
- Temporary restriction of movement around the hip
- Failure to achieve the expected benefit in cases with advanced osteoarthritis
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If groin pain has persisted for a long time
- If sitting, squatting or getting in and out of a car markedly increases the pain
- If there is catching, locking or a sense of giving way in the hip
- If you are an athlete and pain develops on rotational movements
- If symptoms persist despite physiotherapy
Frequently Asked Questions
Does hip arthroscopy treat hip osteoarthritis?
No. In advanced hip osteoarthritis the expected benefit from arthroscopy is limited. In these cases weight control, exercise, pain management and, in suitable patients, joint replacement surgery are considered. Arthroscopy is mainly considered for structural problems before osteoarthritis has developed.
How do we tell whether my groin pain comes from the hip or the back?
Examination findings, the site of the pain and which movements aggravate it give important clues. Where necessary, imaging and, in selected cases, a diagnostic intra-articular injection are used to try to identify the source of the pain.
Will I use crutches after the operation?
In most cases partial weight-bearing with crutches is recommended in the early period. The duration varies with the procedure performed and the course of healing, and is determined by your physician.
If I am an athlete, can I return to the field?
Return to sport is decided by examination and functional testing, not by the calendar. The procedure performed, the type of sport and regaining strength around the hip are decisive. It would not be appropriate to state a specific timeframe here.
Does FAI (impingement) always require surgery?
No. Many people whose X-rays show bone shapes consistent with impingement have no symptoms at all. The treatment decision is based on symptoms and examination findings, not on the image alone.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of hip arthroscopy and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Arthroscopic Surgery (Keyhole Joint Surgery)
- Knee and Hip Problems
- Hip Osteoarthritis
- Joint Replacement Surgery (Knee, Hip and Shoulder Arthroplasty)
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.