Hip arthroscopy is a minimally invasive surgical technique used to diagnose and treat a variety of injuries or disorders of the hip joint.
The hip is what’s known as a “ball and socket” joint. It’s where the ball-shaped head of the femur—the thighbone—meets and fits into the bowl-shaped bone in the pelvis, called the acetabulum.
When the hip is healthy, these components work together, allowing for pain-free movement. But when something goes wrong with one or more parts of your hip joint, it can cause pain and inflammation that reduce mobility and your ability to participate in sports—and even everyday activities.
There are many nonsurgical treatments to help relieve hip pain, including rest, activity modification, and physical therapy, among others. Sometimes, though, surgery is required. Fortunately, many hip repairs and problems can be treated with hip arthroscopy, a minimally invasive surgery that allows patients to recover more quickly than with traditional open surgery. “Hip arthroscopy has advanced considerably and has been applied to treating a wide variety of conditions in and around the hip including hip impingement, labral tears, tendon tears, and bursitis,” says Yale Medicine orthopaedic surgeon Andrew Jimenez, MD. “The advantage of the arthroscopic approach is the ability to have outpatient surgery and an accelerated rehabilitation. Considerable research has been done, which has shown highly reliable outcomes of hip arthroscopy in the right setting.”
What is hip arthroscopy?
Hip arthroscopy is a minimally invasive type of surgery that is used to treat hip joint injuries and disorders, with the aim of relieving symptoms and helping people return to their normal activities without pain.
Injuries and other hip conditions can cause pain, stiffness, reduced range of movement, and “clicking” or “catching” sensations, among other symptoms. Hip arthroscopy encompasses a range of procedures, including shaving down excess bone growths causing impingement, repairing or reconstructing torn labrums, repairing torn tendons, and management of hip bursitis, among others.
Unlike open surgery, which requires a large incision, arthroscopic surgery is less invasive, involving only a few small incisions. In most cases, patients can go home the day of the surgery; recovery from arthroscopic surgery is typically faster than it is for open surgical procedures.
What conditions can be treated with hip arthroscopy?
Hip arthroscopy is used to treat many types of hip problems. Some of these include:
- Femoracetabular impingement (FAI) syndrome, also known as hip impingement. In FAI, bony growths arise on one or both bones of the hip joint. When the hip flexes, these bumps rub against one another, damaging the articular cartilage that covers the bones, as well as the labrum, a ring of cartilage that covers the outer rim of the acetabulum.
- Labral tear. The labrum can tear or get damaged by falls, sports injuries, FAI, hip dysplasia, and degenerative conditions.
- Hip Bursitis. Inflammation can form on the outside of the hip in a bursa—typically an area on the side of the hip that is painful to touch or lie on
- Hip tendon tears. The hip abductor tendons are muscles that insert on the side of the hip. When they are torn, it can make walking difficult and cause weakness of the hip
- Snapping hip syndrome. People with this syndrome may hear a snapping sound or feel a snapping sensation when moving their hip. It is often caused by a tendon sliding over bones in the hip joint.
What happens during hip arthroscopy?
Before the procedure, patients are given an anesthetic in the form of a nerve block to prevent pain. All patients undergo general anesthesia for the surgery. Patients may also be given medication to help them relax before surgery.
At the start of the procedure, the surgeon will use a traction device to slightly separate the bones of the hip joint, making it easier to view and gain access to it. The surgeon then makes a small incision in the skin of the hip through which a thin tube equipped with a light and camera (called an arthroscope) is inserted. The camera transmits video to a monitor in the operating room, allowing the surgeon to visually examine the tissues inside the hip. The surgeon will then make another small incision or two, through which he or she inserts surgical instruments for the procedure, which varies depending on the condition being treated.
When the surgery is complete, the surgeon removes the arthroscope and surgical instruments, then closes the incisions with stitches.
What is recovery like after hip arthroscopy?
Recovery varies, depending on the type of surgical procedure performed, as well as the patient’s age and overall health.
In general, hip arthroscopy is an outpatient procedure, meaning most people can go home the day of the surgery. Patients may be given a prescription for a pain medication and/or take nonsteroidal anti-inflammatory drugs, such as naproxen or ibuprofen. Ice can also help reduce swelling.
Depending on the surgical procedure, patients may need to use crutches for 2 to 6 weeks and avoid putting their full weight on the affected leg during this period. They may also need to wear a brace during that time to limit the hip’s range of motion while it heals.
In many cases, doctors will refer patients to a physical therapist who will guide them through exercises designed to progressively build strength and increase range of motion. Therapy often starts within a week of surgery.
What are some potential complications of hip arthroscopy?
Like all surgery, hip arthroscopy carries certain risks. While complications—especially serious ones—are uncommon, they may include:
- Bleeding in the joint
- Damage to bones, cartilage, labrum, and other tissues in the hip
- Temporary nerve damage
- Blood clots in the leg, known as deep vein thrombosis. (There is a risk that the clot may break away, travel to blood vessels in the lung, and cause a pulmonary embolism.)
- Hip instability
What is the outlook for people who undergo hip arthroscopy?
A person’s outlook depends on several factors, including the type of hip problem they had prior to surgery and the type of surgical procedure they underwent, as well as their age and general health. After following a physical therapy rehabilitation program, most people are able to return to everyday activities, and athletes have shown high rates of return to their sport.
What is unique about Yale Medicine's approach to hip arthroscopy?
“All surgeons performing hip arthroscopy in the Yale Hip Preservation program have additional training specifically in this procedure—they make hip arthroscopy the main focus of their practice,” says Dr. Jimenez. “Additionally, the surgeons are on the cutting edge and use the most up-to-date techniques and technology to provide the highest level of care to their patients. For complex cases, the Yale Hip Preservation program leverages the care of experienced surgeons in multiple fields of hip care to provide the best treatments and outcomes.”