Hip arthroscopy is a specialized, minimally invasive surgical technique used to view, diagnose, and treat problems inside or around the hip joint. It is often called “keyhole surgery” because it uses a few small incisions, or portals, instead of a large incision.
A small instrument called an arthroscope, containing a camera and light, is inserted through one portal. The camera transmits magnified images of the joint’s interior to a video monitor, providing a clear view of the cartilage, labrum, and bone structures. Miniature surgical instruments are then inserted through the other portals to perform the necessary repairs.
Conditions Treated with Hip Arthroscopy
This minimally invasive approach is commonly recommended for specific diagnoses that have not responded to non-surgical treatments like physical therapy or injections. A primary indication is Femoroacetabular Impingement (FAI), a condition where abnormally shaped bone on the ball (femoral head) or the socket (acetabulum) causes the bones to rub together. This friction leads to pain and can damage the soft tissues surrounding the joint.
Arthroscopy is also used to address acetabular labral tears, which are injuries to the ring of cartilage that seals the hip socket. Labral tears can be caused by FAI or trauma, leading to symptoms like clicking, locking, and deep hip or groin pain. Surgeons repair the torn labrum using the arthroscope, often with small anchors and sutures.
Other issues treated include the removal of loose bodies (fragments of bone or cartilage that interfere with movement). Arthroscopy may also be used to treat certain types of cartilage damage, hip joint infection, or to remove inflamed joint lining, a condition known as synovitis.
The Surgical Procedure
The procedure typically begins with the administration of anesthesia, which may be general or regional. Once the patient is positioned, the leg is placed in traction, applying a controlled pulling force to gently separate the ball of the hip from the socket. This separation, often about one centimeter, is necessary to create the space needed to insert the arthroscope and instruments without damaging the joint surfaces.
Fluoroscopy, a type of real-time X-ray imaging, is used to ensure the hip is distracted correctly and to guide the precise placement of the instruments. The surgeon then makes two to four small portals, generally less than a centimeter long, around the hip. A sterile, water-based solution is continuously pumped into the joint to keep the view clear and maintain distention of the joint space.
The arthroscope is inserted through the first portal, allowing the surgeon to examine the central compartment of the hip, including the labrum and articular cartilage. Specialized instruments are then introduced through the other portals to perform the repairs. For FAI, this involves trimming or shaving away the excess bone, a process called osteoplasty, to restore the normal contour of the joint. After the central compartment work is complete and traction is released, the surgeon may address the peripheral compartment, the area outside the primary ball-and-socket joint.
Post-Surgical Recovery and Rehabilitation
Patients are typically monitored briefly following the procedure and often go home the same day, as hip arthroscopy is commonly performed in an outpatient setting. Pain management is a primary focus, often involving nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetic injections performed during the surgery. Post-operative swelling around the hip and thigh is common due to the fluid used, and patients are often advised to use ice and elevation.
Weight-bearing restrictions are determined by the specific procedures performed, especially if a labral repair was done. Patients must use crutches for a period that can range from one to two weeks up to six to eight weeks to protect the healing tissues.
Physical therapy (PT) is an integral component of the recovery process, often beginning within the first few weeks after surgery. The early goals of PT are to protect the repair, manage pain, and restore a pain-free range of motion, with initial exercises focusing on gentle, low-load movements like gluteal and abdominal isometrics. The focus later shifts to strengthening the muscles surrounding the hip, particularly the deep hip rotators, and improving functional stability. While return to daily activities generally occurs over six weeks, a full return to unrestricted heavy exercise or sport typically takes three to six months or longer.
Distinctions from Open Hip Surgery
The fundamental difference between hip arthroscopy and traditional open hip procedures lies in the surgical approach and the resulting trauma to surrounding tissues. Open surgery involves making a single, large incision, which requires cutting through muscle and other soft tissues to fully expose the joint. In contrast, arthroscopy uses multiple small portals, each typically only a few millimeters in length, for the insertion of instruments.
This minimally invasive technique results in significantly less disruption to the muscles and ligaments surrounding the hip joint. Because the muscle dissection is minimized, the procedure generally leads to less post-operative pain, reduced blood loss, and minimal scarring. This reduced tissue trauma often allows for a faster initial recovery period and a shorter hospital stay. However, open surgery, such as surgical hip dislocation, remains necessary for cases with severe joint damage or complex deformities that require a broader, unobstructed field of view.