Hip Arthroscopy

Overview

Hip arthroscopy is a minimally invasive surgical procedure that uses a small camera and specialized instruments to diagnose and treat various conditions inside the hip joint. Through small incisions, surgeons can address labral tears, femoroacetabular impingement, loose bodies, and other hip pathology. The procedure offers advantages including smaller incisions and potentially faster recovery compared to open hip surgery.

Indications

This procedure may be considered when:

• •Femoroacetabular impingement (FAI) with cam or pincer morphology
• •Labral tears of the hip
• •Loose bodies within the hip joint
• •Synovitis or inflammatory conditions of the hip
• •Mild hip dysplasia with labral pathology (in selected cases)
• •Snapping hip syndrome (internal or external)
• •Hip joint infection (diagnostic and therapeutic)
• •Ligamentum teres tears
• •Cartilage lesions (chondral damage)

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is performed under general or regional anesthesia
• •The patient is positioned supine or lateral on a specialized fracture table
• •Traction is applied to separate the femoral head from the acetabulum for access
• •Small portals are created around the hip joint
• •A camera (arthroscope) is inserted to visualize the joint interior
• •The central compartment (acetabulum, femoral head, labrum) is examined
• •The peripheral compartment (femoral neck, capsule) is also evaluated
• •Therapeutic procedures are performed: labral repair or debridement, osteoplasty for impingement, loose body removal
• •Traction is released and capsular closure may be performed
• •Portals are closed with sutures or adhesive strips

Risks

As with any surgical procedure, potential risks include:

• •Traction-related nerve injury (particularly sciatic, femoral cutaneous, or pudendal nerves)
• •Heterotopic ossification (bone formation in soft tissues)
• •Infection of the surgical site or joint
• •Persistent pain or stiffness
• •Progression to hip arthritis despite treatment
• •Labral repair failure
• •Avascular necrosis of the femoral head (rare)
• •Fluid extravasation into surrounding tissues
• •Blood clots
• •Need for revision surgery or conversion to hip replacement

Recovery Expectations

Recovery follows a gradual progression:

• •Most procedures are performed as outpatient surgery
• •Crutches or other assistive devices are typically used for 2 to 6 weeks
• •Weight bearing restrictions vary based on the procedure performed
• •Physical therapy begins soon after surgery focusing on range of motion
• •Progression to strengthening exercises occurs over weeks to months
• •Return to desk work may occur within 1 to 2 weeks
• •Return to sports or demanding activities may require 4 to 6 months
• •Full recovery and optimal outcomes may require 6 to 12 months

Alternatives

Depending on individual circumstances, alternatives may include:

• •Physical therapy and conservative management
• •NSAIDs and other medications for pain relief
• •Intra-articular hip injections (corticosteroid or hyaluronic acid)
• •Activity modification and lifestyle changes
• •Periacetabular osteotomy for hip dysplasia
• •Total hip arthroplasty for end-stage arthritis

Sources

• AAOS OrthoInfo – Hip Arthroscopy
• Mayo Clinic – Hip Arthroscopy
• Cleveland Clinic – Hip Arthroscopy
• Johns Hopkins Medicine – Hip Arthroscopy