Hip arthroscopy is a minimally invasive surgery where a surgeon inserts a small camera and thin instruments through two or three small incisions around the hip joint. It’s used to diagnose and repair a range of hip problems, from torn cartilage to bone abnormalities, without opening the joint with a large incision. The procedure has become increasingly common over the past decade as techniques have improved, and most people recover within a few months.
Why It’s Done
The most common reasons for hip arthroscopy are labral tears and femoroacetabular impingement (FAI). The labrum is a ring of cartilage that lines the rim of your hip socket, and it can tear from injury, repetitive motion, or structural issues with the joint. FAI happens when extra bone grows along one or both of the bones forming the hip joint, causing them to rub against each other during movement. Over time, this friction damages the joint and limits range of motion.
Beyond these two conditions, hip arthroscopy can address loose fragments of cartilage or bone floating inside the joint, damage to the ligament connecting the thighbone to the hip socket, hip joint infections, snapping hip syndrome (where a tendon catches on bone during movement), and certain types of pain around the outer hip. It’s also used to treat less common problems like nerve compression in the deep tissue behind the hip.
What Happens Before Surgery
Before you’re cleared for hip arthroscopy, your doctor will perform specific physical exams to reproduce your symptoms and pinpoint the source of your pain. One of the most reliable is the FADIR test, where the doctor flexes your hip, rotates it inward, and moves your knee across your body. This test has a sensitivity of 99%, meaning it catches nearly all cases of impingement. Other exams include the FABER test, which moves the hip in the opposite direction, and assessments of your gait and ability to squat.
Imaging confirms the diagnosis. MRI is the most commonly ordered scan, used in roughly half of cases, and is especially useful for spotting labral tears and other soft tissue damage. A version called MR arthrography, where contrast dye is injected into the joint before scanning, gives even clearer images of the labrum. CT scans are ordered about a quarter of the time, primarily to evaluate bone shape and structural abnormalities rather than soft tissue.
How the Surgery Works
Hip arthroscopy is typically performed under general anesthesia, though regional options like spinal blocks or peripheral nerve blocks (which numb specific nerves in the thigh) are sometimes used. You’re positioned on a specialized traction table that gently pulls your leg to create space inside the tightly fitting hip joint. The surgeon needs only about 8 to 10 millimeters of separation between the ball and socket to work.
Getting that space is one of the trickier parts of hip arthroscopy compared to knee or shoulder procedures. The hip joint has a strong vacuum seal created by the capsule surrounding it. To break that seal, the surgeon inserts a needle through the capsule and injects air, which eliminates the negative pressure holding the joint together and makes distraction much easier.
Once the joint is open, the surgeon makes two or three small portal incisions and inserts a camera (arthroscope) through one and instruments through the others. The camera projects a magnified image of the inside of the joint onto a monitor. Depending on the problem, the surgeon may trim or reattach torn labral tissue, shave down excess bone causing impingement, remove loose bodies, or address cartilage damage. Fluid is circulated through the joint throughout the procedure to maintain visibility and flush out debris.
Recovery and Returning to Activity
Most people need a few months to fully recover. In the first week, you won’t put any weight on the operated hip. You’ll use crutches for one to two weeks and typically wear a hip brace for about three weeks to protect the repair while it heals. After the initial period, you can gradually start walking and bearing more weight.
Physical therapy is a central part of recovery and can last anywhere from a few weeks to a few months. The early focus is on restoring range of motion and preventing stiffness, then progressively building strength. For people aiming to return to running, a walking program comes first. You should be able to walk 30 minutes pain-free at a brisk pace (around 3.5 miles per hour) before progressing. Jogging is generally allowed around 8 to 10 weeks after straightforward labral procedures.
Return to sports typically falls between 12 and 20 weeks, with 70% of surgeons recommending this window. Competitive athletes may need anywhere from 10 to 32 weeks depending on the sport and the complexity of the repair. Patients who undergo cartilage restoration procedures start their timeline about six weeks later than others because they’re kept non-weight-bearing for the first six postoperative weeks.
Risks and Complications
Hip arthroscopy is considered low-risk, but complications do occur. The most notable is nerve injury, which reported rates place between 1.4% and 5% based on standard follow-up. A study that specifically tested for nerve function found a higher incidence of 13%, suggesting that milder nerve irritation often goes unreported because patients don’t mention subtle symptoms. The pudendal nerve, which runs through the groin area and can be compressed by the traction post during surgery, is the most commonly affected. Numbness or tingling along the outer thigh from irritation of the lateral femoral cutaneous nerve is another possibility. Most of these nerve issues resolve on their own over weeks to months.
Other potential complications include infection, blood clots, stiffness, and continued pain. There’s also a risk that the procedure won’t fully resolve symptoms, particularly in patients with more advanced joint damage.
Long-Term Outcomes
Short-term results after hip arthroscopy are generally positive, with most patients reporting significant pain relief and improved function within the first few years. The longer-term picture is more nuanced. A study tracking patients for an average of 12 years after arthroscopy for femoroacetabular impingement found that about 55% of hips reached a level that patients considered an acceptable outcome. On the other end, 31% fell below that threshold, 5% needed a second arthroscopy, and 9% eventually required a total hip replacement, putting the overall failure rate at 45% over that timeframe.
These numbers reflect a specific population followed for over a decade, and outcomes depend heavily on factors like the severity of joint damage at the time of surgery, age, and body weight. People with early-stage problems and otherwise healthy cartilage tend to do considerably better than those with more advanced wear. Hip arthroscopy works best as an intervention before significant arthritis has set in, not as a treatment for arthritis itself.