Hip arthroscopy is a surgical procedure that allows doctors to view the hip joint without making a large incision (cut) through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide range of hip problems.

During hip arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities. Hip arthroscopy has been performed for many years but is not as common as knee or shoulder arthroscopy.

Who Needs It

Your doctor may recommend hip arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.

Hip arthroscopy may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. Although this damage can result from an injury, other orthopaedic conditions can lead to these problems, including:

  • Femoroacetabular impingement (FAI) is a disorder in which extra bone develops along the acetabulum (pincer impingement) or on the femoral head (cam impingement). This bone overgrowth—called spurs—damages the soft tissues of the hip during movement. Sometimes, bone spurs develop in both the acetabulum and femoral head. In femoroacetabular impingement, bone grows abnormally around the hip socket (pincer impingement) or femoral head (cam impingement). Arthroscopy is typically used to trim the excess bone.
  • Ischiofemoral Impingement (IFI) is a common disorder in women over the age of 40 where the femur hits the pelvis, causing buttock (posterior hip) and lower back pain.
  • Dysplasia is a condition in which the hip socket is abnormally shallow. This puts more stress on the labrum to keep the femoral head within the socket and makes the labrum more susceptible to tearing. Often, this is done in conjunction with a peri-acetabular osteotomy (PAO)
  • Snapping hip syndromes cause a tendon to rub across the outside of the joint. This type of snapping or popping is often harmless and does not need treatment. In some cases, however, the tendon is damaged from the repeated rubbing.
  • Synovitis causes the tissues that surround the joint to become inflamed.
  • Loose bodies are fragments of bone or cartilage that become loose and move around within the joint.
  • Hip joint infection

How Does It Work

Positioning

At the start of the procedure, your leg will be put in traction. This means that your hip will be pulled away from the socket enough for your surgeon to insert instruments, examine the entire joint, and perform the necessary treatments.

Surgeons typically draw lines on the hip to indicate specific anatomical structures (such as bone, nerves, and blood vessels), as well as incision placements and portals for the arthroscope.

Procedure

After traction is applied, your surgeon will make a small puncture in your hip (about the size of a buttonhole) for the arthroscope. Through the arthroscope, he or she can view the inside of your hip and identify damage.

Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen, showing your surgeon the inside of your hip and any problems. Your surgeon will evaluate the joint before beginning any specific treatments.

Your surgeon inserts the arthroscope through a small incision about the size of a buttonhole. Other instruments are inserted to treat the problem.

Once the problem is clearly identified, your surgeon will insert other small instruments through separate incisions to repair it. A range of procedures can be done, depending on your needs. For example, your surgeon can:

  • Smooth off torn cartilage or repair it
  • Trim bone spurs caused by FAI
  • Repair the acetabular labrum
  • Remove inflamed synovial tissue

Specialized instruments are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.

The length of the procedure will depend on what your surgeon finds and the amount of work to be done. At the end of surgery, the arthroscopy incisions are usually stitched or covered with skin tapes. An absorbent dressing is applied to the hip.

Recovery

After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. You will need someone to drive you home and stay with you at least the first night. You can also expect to be on crutches or a walker for some period of time.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Medications

In addition to medicines for pain relief, your doctor may also recommend medication such as aspirin to lessen the risk of blood clots.

Bearing Weight

Crutches may be necessary after your procedure. In some cases, they are needed only until any limping has stopped. If you required a more extensive procedure, however, you may need crutches for 1-2 weeks. If you have any questions about bearing weight, call your surgeon.

Your surgeon will develop a rehabilitation plan based on the surgical procedures you required. In most cases, physical therapy is necessary to achieve the best recovery. Specific exercises to restore your strength and mobility are important. Your therapist can also guide you with additional do's and don'ts during rehabilitation.