Hip Arthroscopy

The hip is a ball-and-socket joint built for load. The ball is the femoral head at the upper end of your thigh bone; the socket is the acetabulum, a cup where three pelvic bones meet.

Around the socket rim runs the labrum, a ring of dense fibrocartilage that deepens the cup and creates a suction seal. That seal holds fluid under pressure between ball and socket, keeping cartilage lubricated and spreading load instead of concentrating it. Beneath it, articular cartilage coats both surfaces; outside it, a thick capsule and the gluteal muscles control the joint.

Hip arthroscopy is keyhole surgery inside the joint. Through two or three incisions about the width of a pencil, a camera and thin instruments enter the hip under X-ray guidance.

Reaching the hip is harder than reaching a knee or shoulder: it is deep, tightly contained, and wrapped in muscle. Gentle traction opens a working space for part of the case, then is released so the front of the joint can be addressed with the hip flexed. Common work includes labral repair or reconstruction, reshaping of the femoral neck or socket rim, cartilage treatment, and capsular repair.

• Femoroacetabular impingement (FAI). Extra bone on the femoral neck (cam), an over-covered rim (pincer), or both, pinching the labrum in deep flexion.
• Labral tears. Usually at the front and upper socket, most often driven by impingement rather than one injury.
• Cartilage injury. Flaps peeling off the socket rim, next to a labral tear.
• Loose bodies. Fragments of cartilage or bone inside the joint.
• Internal snapping hip. A tight iliopsoas tendon snapping across the joint.
• Capsular laxity. More common in gymnasts, dancers, and hypermobile athletes.
• Gluteal tendon tears. Stubborn pain on the outside of the hip.

The classic complaint is pain deep in the front of the hip or groin, often shown by cupping the hip between thumb and forefinger, a pattern called the C-sign. Others include:

• Pain after sitting a long stretch, in the car or at a desk
• A pinch when squatting deep or putting on shoes and socks
• Clicking, catching, or a sense that the joint gives way
• Buttock or outer hip ache, often mistaken for a back problem

Diagnosis starts with a history and a hands-on exam. Motion is measured in both hips and compared, provocative tests such as flexion-adduction-internal rotation help localize the problem, and the back and pelvis are checked too.

X-rays come first, and they have to be the right ones: a well-centered AP pelvis, a Dunn or cross-table lateral, and a false profile view. These show the shape of the bone and how much cartilage space remains. MRI, often with contrast in the joint, shows the labrum. If a diagnostic injection numbs your pain for a few hours, it is coming from inside the joint.

Good candidates share four features: symptoms that match the exam, imaging that explains them, well-preserved cartilage space, and a fair trial of nonoperative care that did not hold. Most patients should first complete eight to twelve weeks of therapy aimed at gluteal strength and core control.

Who is not a candidate matters just as much. Cam-shaped bone appears on imaging in many people who never develop hip pain, so an abnormal X-ray alone is not a reason to operate. Joint space narrowing predicts a poor result from arthroscopy, and significant dysplasia may call for a different operation, such as a periacetabular osteotomy, which is referred out.

• Stop nicotine in every form; it measurably impairs soft-tissue and bone healing.
• Pause anti-inflammatories and blood thinners as directed.
• Start prehabilitation; strong glutes shorten the first phase of recovery.
• Line up physical therapy so your first visit falls within days.
• Arrange a driver, crutches, and a bed that does not require stairs.

1. Anesthesia. General anesthesia with muscle relaxation, usually with a regional block.
2. Traction. Gentle traction opens a few millimeters inside the joint, kept as brief as possible.
3. Portals and survey. Two or three portals are placed under X-ray guidance, a capsular window is made, and the whole joint is inspected and documented.
4. Labral treatment. A torn labrum is repaired to the rim with suture anchors to restore the seal; an irreparable labrum may be reconstructed with a graft.
5. Bone reshaping. With traction released, pincer and cam bone are reshaped with a burr, and the correction is confirmed on X-ray and by moving the hip.
6. Closure. The capsule is repaired, portals closed, and you go home the same day.

Hip arthroscopy is outpatient surgery, but rehabilitation is a real commitment. Expect four to nine months before you are back in sport, longer for high-level cutting and contact.

Weeks 0 to 2

Crutches with flat-foot partial weight bearing protect the repair. Therapy begins within days: stationary bike, isometrics, swelling control. Active hip flexion and end-range rotation are limited.

Weeks 2 to 6

Crutches are weaned once you can walk without a limp. Motion opens up and closed-chain strengthening begins.

Weeks 6 to 12

Progressive gluteal and core strengthening, elliptical, and pool work.

Months 3 to 5

A graded return-to-running program once hip strength is symmetric and gait is normal, then agility drills.

Months 4 to 9

Return to sport is decided by criteria, not the calendar: pain-free motion, hip and core strength close to the other side, and a completed sport-specific progression. Ask for a therapist experienced in hip preservation rehabilitation; there are good options in Annapolis and Severna Park.

Hip arthroscopy is generally well tolerated, but no operation is risk-free. Possible complications include temporary numbness in the groin or outer thigh from traction, infection, bleeding, blood clot, and heterotopic ossification, which is why a short course of anti-inflammatory medication is often prescribed. Less common are cartilage injury during instrument passage, femoral neck fracture from over-resection, stiffness, incomplete pain relief, later joint wear, and anesthesia risks.

No surgeon can guarantee an outcome. What you can expect is a candid assessment of whether you are likely to benefit, and an equally candid conversation if you are not.