ORTHOPEDICS + SPORTS MEDICINE
Hip Arthroscopy
Minimally invasive treatment for labral tears, impingement, and other causes of persistent hip pain.
Not all hip pain is caused by advanced arthritis, and not every surgical problem requires joint replacement. Tears, loose fragments, inflammation, and abnormal contact between the bones can cause pain even when much of the joint remains healthy. Hip arthroscopy allows these problems to be treated through small openings while preserving the patient’s natural hip.
At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, hip arthroscopy is considered only after the source of pain has been carefully identified. The procedure is most useful when imaging and examination point to a specific problem inside the joint that has not improved with rest, medication, injections, or physical therapy.
Inside the Hip Joint
The hip is a ball-and-socket joint formed by the femoral head at the top of the thighbone and the acetabulum within the pelvis. Articular cartilage covers both surfaces and allows them to move smoothly against each other.
A ring of strong tissue called the labrum surrounds the edge of the socket. The labrum deepens the joint, contributes to stability, and helps maintain a seal around the femoral head. Ligaments form a capsule around the joint, while a thin synovial lining produces fluid for lubrication.
Damage to any of these structures can affect the way the hip moves. Because hip pain can also originate in muscles, tendons, the lower back, or areas outside the joint, identifying the correct source is an essential part of planning treatment.
Problems Treated With Hip Arthroscopy
Hip arthroscopy is used to examine and treat selected conditions inside and around the joint. Common examples include:
- Labral tears
- Femoroacetabular impingement
- Damaged or unstable cartilage
- Loose pieces of bone or cartilage
- Inflamed synovial tissue
- Certain snapping hip conditions
- Selected tendon injuries
Femoroacetabular impingement, or FAI, occurs when extra bone along the femoral head or acetabulum causes abnormal contact during movement. This contact can damage the labrum and cartilage, particularly when the hip bends or rotates.
A labral tear may develop from an injury, repeated motion, impingement, or differences in hip anatomy. Symptoms can include groin pain, clicking, catching, stiffness, and discomfort with prolonged sitting or athletic activity.
Determining Whether Arthroscopy Is Appropriate
A hip evaluation begins with the pattern and location of the patient’s symptoms. The specialist assesses motion, strength, walking mechanics, and the positions that reproduce pain.
X-rays can show the shape and alignment of the bones, while MRI or other advanced imaging may provide information about the labrum, cartilage, and surrounding soft tissues. In some cases, an injection into the joint helps determine whether the pain is coming from inside the hip.
Hip arthroscopy may be considered when:
- Symptoms have not improved with nonsurgical care
- A specific, treatable source of pain has been identified
- Joint damage is not too advanced for preservation
- Pain is interfering with activity, work, or sports
- The patient can participate in postoperative rehabilitation
Arthroscopy is generally less predictable when the hip has extensive cartilage loss or advanced arthritis. In those cases, treating the labrum or reshaping bone may not address the primary source of pain.
How Hip Arthroscopy Is Performed
Hip arthroscopy is commonly performed under general anesthesia. The leg is placed in gentle traction to create enough space between the ball and socket for the camera and instruments to enter the joint.
The surgeon creates several small openings called portals. A slender camera, or arthroscope, is inserted through one portal and sends a detailed view of the joint to a monitor. Sterile fluid helps expand the space and maintain a clear view.
Small surgical instruments are introduced through the other portals. The work performed depends on the condition found inside the hip and may include:
- Repairing or stabilizing a torn labrum
- Trimming abnormal bone associated with impingement
- Smoothing damaged cartilage
- Removing loose fragments
- Removing inflamed joint tissue
- Treating selected tendon problems
When a labrum can be preserved, it may be repaired with sutures secured near the rim of the socket. When impingement is present, the surgeon can reshape the responsible area of bone to reduce abnormal contact during hip movement.
The procedure is usually completed on an outpatient basis. Its length varies according to the number and complexity of the problems being treated.
Recovery Depends on What Was Treated
Patients generally use crutches after hip arthroscopy. The amount of weight permitted on the operated leg depends on whether the procedure involved a simple removal of damaged tissue, a labral repair, cartilage treatment, or bone reshaping.
Restrictions may be brief after a limited procedure or continue for several weeks after a more extensive repair. Swelling, muscle soreness, and temporary discomfort around the incisions are expected during early recovery.
Patients receive instructions covering:
- Incision and dressing care
- Weight-bearing restrictions
- Use of crutches
- Safe sleeping and sitting positions
- Medication and blood-clot prevention
- Movements that should be temporarily avoided
Progress is based on tissue healing and movement quality rather than a single timeline. Returning to sports usually requires more time than returning to basic household or work activities.
Physical Therapy After Hip Arthroscopy
Physical therapy is a central part of recovery. The hip can become stiff, and the surrounding muscles may weaken while activity is restricted. Rehabilitation helps restore movement without placing too much stress on healing tissue.
The program typically progresses through several stages. Early therapy concentrates on protected motion, reducing swelling, and maintaining a normal walking pattern with crutches. Later phases introduce strengthening for the hip, core, and leg, followed by balance and movement training.
For athletic patients, therapy eventually becomes specific to running, cutting, lifting, or other demands of their sport. Advancement should be based on strength, control, and the absence of increasing pain rather than time alone.
When to Have Hip Pain Evaluated
Persistent groin pain, catching, locking, or discomfort with hip rotation should be evaluated when it begins limiting activity. Pain that continues despite rest and physical therapy, or repeatedly returns when sports resume, may indicate a structural problem inside the joint.
An orthopedic assessment is also important before assuming that a labral tear seen on imaging is responsible for the symptoms. Imaging findings must be considered alongside the examination because some hip abnormalities do not cause pain or require surgery.
Summary
Hip arthroscopy provides access to structures that cannot be fully evaluated or treated from outside the joint. Its value lies in addressing a defined problem while retaining the patient’s natural ball-and-socket anatomy.
A successful treatment plan also accounts for bone shape, cartilage condition, muscle function, and rehabilitation. At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, these factors help determine whether arthroscopy offers a reasonable path back to comfortable movement.