Hip arthroscopy is a minimally invasive surgery where a surgeon uses a small camera and specialized instruments inserted through a few small incisions to diagnose and repair problems inside your hip joint. Instead of opening the joint with a large incision, the surgeon works through two or three puncture-sized openings, each roughly the width of a pencil. The camera sends a live image to a screen, giving the surgeon a detailed view of the cartilage, labrum, and bone surfaces without cutting through surrounding muscle.
How the Procedure Works
The hip is a deep, tightly fitted ball-and-socket joint, which makes accessing it more challenging than a knee or shoulder. To create enough room for instruments, the surgical team applies traction to your leg, gently pulling the ball of the femur away from the socket until there’s about 8 to 10 millimeters of space, confirmed on a live X-ray image. You’re under general anesthesia during this process, so you won’t feel the pulling force.
Once the joint is distracted, the surgeon typically creates three small portals (entry points) around the hip. One sits just above and in front of the bony prominence on the outer hip, another is placed a few finger widths toward the front of the thigh, and a third sits several centimeters below the first. Through these portals, the surgeon can insert the camera, a probe for examining tissues, a shaver for trimming damaged cartilage, grasping tools, and a device that uses controlled heat to seal or remove tissue. The entire procedure is guided by the camera feed, and the surgeon works on the interior of the joint without ever fully opening it.
Conditions It Treats
The most common reason for hip arthroscopy is femoroacetabular impingement, a condition where extra bone on the rim of the hip socket or on the ball of the femur causes the two surfaces to pinch against each other during movement. Over time, that pinching damages the labrum, the ring of cartilage that lines the edge of the socket and helps seal the joint. During arthroscopy, the surgeon can shave down the excess bone and repair or trim the torn labrum.
Other problems treated arthroscopically include loose fragments of cartilage or bone floating inside the joint, snapping hip caused by a tight tendon, early cartilage damage on the joint surface, and certain types of hip instability. The procedure is also used diagnostically when imaging hasn’t provided a clear answer about the source of hip pain.
Who Is Not a Good Candidate
Hip arthroscopy works best when the joint still has meaningful cartilage intact. Advanced osteoarthritis, where the cartilage is fully worn away, is an absolute contraindication. On X-ray, a joint space narrower than 2 millimeters or more than 50 percent joint space narrowing predicts poor outcomes and a higher chance of eventually needing a total hip replacement anyway. If your hip joint is stiff to the point of near-complete immobility, the instruments can’t be safely positioned inside.
Structural instability from hip dysplasia, where the socket is too shallow to cover the femoral head, is also poorly suited to arthroscopy alone. These patients typically need a more involved procedure to reposition the socket. Similarly, severe deformities from childhood conditions like slipped growth plates are better addressed through open surgery. Obesity increases technical difficulty because standard instruments may not be long enough to reach the joint, and existing nerve conditions in the leg or pelvis can be worsened by the traction required during the procedure.
Imaging Before Surgery
Before recommending arthroscopy, your surgeon will typically order standard X-rays to assess joint space, bone shape, and any signs of arthritis. An MRI with contrast dye injected into the joint (called an MR arthrogram) provides the most detailed look at the labrum and cartilage. In one study of revision cases, this type of imaging detected internal scar tissue with 90.6 percent sensitivity, showing how precisely it can map soft tissue problems before surgery begins. The combination of your symptoms, physical exam findings, and imaging results determines whether arthroscopy is likely to help.
Recovery Timeline
Recovery depends heavily on what was done inside the joint. For simpler procedures like trimming a torn labrum or releasing a tight tendon, most surgeons allow you to put weight on the leg right away, often with crutches for comfort. If the labrum was repaired with stitches rather than trimmed, or if cartilage restoration techniques were used, expect to stay off the leg for anywhere from three to eight weeks. Cartilage procedures, particularly microfracture (where small holes are drilled into bone to stimulate new cartilage growth), require the longest period of restricted weight bearing, sometimes six weeks or more.
After surgery, you may be given a continuous passive motion (CPM) machine, a device that slowly bends and straightens your hip while you rest. In clinical trials, patients who used a CPM machine for four to six hours daily during the first two weeks after surgery reported less pain than those who didn’t. Crutches are standard for the first several weeks regardless of the procedure performed.
Physical therapy usually begins within the first week or two. The majority of surgeons clear patients to start running again between three and four months after surgery. Return to impact sports like basketball, soccer, or tennis generally takes four to six months, though procedures involving cartilage repair push that timeline further. Over 80 percent of surgeons delay return to running and sports after microfracture procedures specifically.
Risks and Complications
Because the surgery requires pulling the leg to open the joint space, nerve irritation from traction is the most closely tracked complication. In a prospective study of 200 patients, 2 percent developed temporary numbness or nerve symptoms after surgery. All cases resolved completely, three within six to nine weeks and one, which involved the longest traction time, within 12 weeks. No patient who had traction applied for less than 20 minutes developed any nerve symptoms, and keeping traction time under about 30 minutes was associated with fewer issues overall.
Other potential complications include infection (rare with any arthroscopic procedure), stiffness, fluid buildup, and in uncommon cases, a blood clot. The small incisions typically heal with minimal scarring.
Long-Term Outcomes
Patient satisfaction early after surgery is a strong predictor of how the hip will perform over time. In a study tracking patients for at least 10 years after hip arthroscopy for impingement, those who reported high satisfaction at the two-year mark continued to score significantly better on measures of daily function, sports ability, and pain. They also had a dramatically lower rate of needing additional surgery: just 1.8 percent compared to 24.1 percent among those with lower early satisfaction.
The patients most likely to do well are those with a specific, repairable problem like a labral tear or bone impingement, adequate remaining cartilage, and no underlying structural instability. When those criteria are met, hip arthroscopy reliably reduces pain, improves range of motion, and allows a return to an active lifestyle.