Hip arthroscopy is a minimally invasive surgical procedure orthopedic surgeons use to diagnose and treat a variety of problems affecting the hip joint. It involves using a specialized fiber-optic instrument called an arthroscope, which contains a camera and a light source. The procedure allows the surgeon to visualize the interior of the hip joint, including the cartilage, labrum, and bone, without a large incision. This technique enables precise repair or removal of damaged tissue through several small, puncture-like cuts, resulting in less pain and a faster initial recovery than traditional open surgery.
Conditions Treated by Hip Arthroscopy
The most frequent reason for hip arthroscopy is to address a tear in the acetabular labrum, a ring of cartilage lining the hip socket that helps maintain joint stability. Labral tears often cause a catching sensation or persistent pain in the groin. Surgeons use the arthroscope to either repair the torn tissue using sutures and anchors or remove the damaged portion.
The procedure is also commonly used to treat Femoroacetabular Impingement (FAI), a condition where extra bone growth on the femoral head or the acetabulum causes the bones to rub abnormally. This structural conflict can damage the labrum and the articular cartilage. The surgeon uses the arthroscope to reshape the bone in a process called osteoplasty.
Hip arthroscopy can also address other mechanical issues, such as the removal of loose bodies (fragments of bone or cartilage floating within the joint that cause locking or pain). Surgeons may also use the technique for early-stage osteoarthritis débridement, smoothing out frayed cartilage flaps to reduce irritation. In rare cases, the procedure can wash out the joint and remove infected tissue in cases of septic arthritis.
The Surgical Process
Hip arthroscopy is typically performed under general or regional anesthesia to ensure comfort and muscle relaxation. The patient is positioned on a specialized surgical table that allows for the application of traction to the leg. Traction gently pulls the femoral head away from the acetabulum to create a small working space within the joint.
Creating this working space (often only a few millimeters wide) is essential for inserting instruments and the arthroscope without damaging joint surfaces. Once distracted, the surgeon makes several small incisions, known as portals, usually less than a centimeter in length, around the hip. The arthroscope is inserted through one portal, transmitting clear, magnified images of the joint interior to a monitor.
Another portal is used for the inflow of sterile fluid, which continuously irrigates the joint to maintain visibility and clear away debris. Specialized miniature instruments are then inserted through the remaining portals to perform necessary repairs, such as shaving down bone spurs in FAI or repairing a torn labrum. The entire process often takes between one and three hours to complete, after which the traction is released and the small incisions are closed.
Recovery and Rehabilitation
Hip arthroscopy is often performed as an outpatient procedure, allowing most patients to return home the same day once the effects of anesthesia have worn off. Managing pain and swelling is a primary focus immediately following surgery, typically through prescribed oral medication and consistent ice therapy. Patients are instructed to use crutches or another assistive device to limit weight-bearing for two to four weeks, depending on the extent of the repair.
Physical therapy (PT) is a cornerstone of the recovery process and usually begins within the first few days after the operation. The early phase of PT focuses on gentle, controlled range-of-motion exercises to prevent stiffness and protect the surgical repairs. As healing progresses, the rehabilitation program shifts to strengthening the muscles surrounding the hip for long-term joint stability and function.
Patients with desk jobs can often return to work within a few days to a week. However, a full recovery, including a return to high-impact activities or sports, is a longer, phased process. While many patients achieve milestones within six to twelve weeks, it can take three to six months for the hip to fully heal and return to pre-injury activity levels. Adherence to the physical therapy protocol is the most significant factor in determining long-term success.
Potential Complications
While hip arthroscopy is considered a safe procedure, risks common to any surgery include infection at the incision sites or an adverse reaction to anesthesia. A specific risk relates to the mechanical application of traction needed to open the joint space. This pulling force can temporarily irritate the surrounding nerves, which is the most common complication reported.
Nerve irritation typically manifests as temporary numbness or tingling in the groin, thigh, or foot, often affecting the pudendal, sciatic, or lateral femoral cutaneous nerves. These symptoms are usually short-lived, resolving within days or weeks as swelling subsides and the nerves recover. Less common but more serious risks include the formation of a deep vein thrombosis (DVT), or blood clot, in the leg.
Another specific concern involves the perineal post, the padded support against which the traction is applied, which can cause temporary soft tissue injury to the groin area. In rare instances, surgical instruments could sustain damage, such as breakage within the joint. Overall, the complication rate for hip arthroscopy is low, with the majority of issues being minor and temporary.