Hip arthroscopy

What is hip arthroscopy?

A hip arthroscopy allows your surgeon to see inside your hip using a camera inserted through small cuts in your skin. It can be used to diagnose structural issues in your hip joint and to treat any problems.

What conditions can hip arthroscopy diagnose?

Your surgeon can diagnose the following problems during a hip arthroscopy:

• Femoroacetabular impingement (FAI): FAI is where extra bone growth on the ball or socket of the hip causes friction and damage to the cartilage lining the joint.
• Labral tears: The labrum is a ring of cartilage around the hip socket, and a labral tear can be due to trauma, early arthritis, impingement or hip dysplasia (shallow socket).
• Cartilage damage: This can be due to trauma, structural deformities like FAI, overuse through repetitive movements, or osteoarthritis.
• Loose bodies: Fragments of bone or cartilage floating in the joint can cause friction and damage to the remaining cartilage.
• Tendon problems: Pain arising from tendons can be caused by trauma, repetitive strain from exercise, muscle weakness or imbalances, poor biomechanics or scarring from previous surgery.
• Synovitis: Synovitis is inflammation of the joint lining (synovium) due to rheumatoid arthritis and other inflammatory conditions.
• Hip joint infections: Also called septic arthritis, this is caused by bacteria or fungi that enter the space through the bloodstream from another infection, direct injury, or surgical procedures.
• Sciatic nerve compression: Also known as sciatica, this is pain caused by irritation or pressure on the sciatic nerve, typically from a disc prolapse/herniated disc, but sometimes from local scarring and soft tissue problems.
• Ischiofemoral impingement (IFI): This rare condition results from entrapment of soft tissues caused by narrowing of the space between the and the upper end of the femur.

What treatments can be performed with hip arthroscopy surgery?

Your surgeon may be able to treat some of the above problems using specialised surgical instruments without making a larger incision (cut).

• Bone reshaping: If you have femoroacetabular impingement (FAI), the excess bone can be sculpted to restore more normal joint mechanics.
• Labral repair or reconstruction: Surgeons can remove, repair or reconstruct the labrum using sutures (stitches) and bone anchors (a device that attaches soft tissues, like tendons or ligaments, firmly to the bone).
• Cartilage smoothing or microfracture: Damage to articular cartilage can be smoothed or removed through microfracture to reduce pain, improve joint function and stimulate healing.
• Removal of loose bodies: Fragments of bone or cartilage floating in the joint can be removed to prevent mechanical symptoms and inflammation.
• Tendon repair or release: Torn tendons (e.g., gluteus medius/minimus) can be repaired or reattached, while tight tendons (which can cause snapping hip syndrome) can be released or lengthened.
• Synovectomy: This is a treatment for synovitis, which involves removing inflamed tissue.
• Debridement: If the hip joint is infected, arthroscopy can be used to irrigate and debride infected tissue.
• Decompression for ischiofemoral impingement (IFI) or sciatica: Arthroscopy can be used to decompress the contents of the ischiofemoral space, such as the sciatic nerve and quadratus femoris muscle, by releasing the tissue causing the impingement/compression.

Is a hip arthroscopy right for me?

You might need a hip arthroscopy if you have any of the following symptoms and they haven't responded to non-surgical treatments like physiotherapy, rest or injections:

• Persistent joint pain
• Swelling
• Stiffness
• Mobility issues.

Also, if your scans haven't given your consultant (surgeon) a clear answer, a hip arthroscopy can help identify the problem.

What happens during the hip arthroscopy procedure?

Arthroscopy takes between 30 and 90 minutes and is often performed as a day case with the patient under general anaesthetic. In some cases, a local anaesthetic may also be used. Your anaesthetist will discuss the options with you.

Preparing for a hip arthroscopy

There are a few things you can do in the lead-up to the procedure to make sure everything goes as smoothly as possible:

• Let your consultant (surgeon) know about any medication you take and follow their advice.
• If you are taking an oral contraceptive pill containing oestrogen, it is recommended to stop this four weeks before surgery to reduce the risks of blood clots in the post-operative period. During this time, alternative methods of contraception should be used or a change to a medication that does not contain oestrogen. This can be discussed with your primary care physician.
• If you are using hormone replacement therapy (HRT) and taking tablets containing oestrogen, it is recommended to stop this four weeks before surgery to reduce the risks of blood clots in the post-operative period. It is appreciated that stopping HRT can cause significant symptoms, so a balance of risks and benefits can be considered and discussed with your surgeon. If you are taking HRT via patches, this can continue as normal.
• If you smoke, please stop smoking at least four weeks before the operation to reduce your risk of complications.
• Try to maintain a healthy weight. If you are taking a weight-loss medication, please inform the medical team looking after you.
• Exercise regularly.
• Don’t shave or wax the area in the week beforehand.
• Try to have a bath or shower either the day before or on the day of the operation.
• Don’t eat or drink for six hours before the surgery. You can continue to drink water up to two hours before your operation.
• If you are diabetic, keep your blood sugar levels under control.
• Keep warm around the time of the procedure.

During the procedure

1. Once you have been given a general anaesthetic and are asleep, you will be placed on a special operating table which allows traction to be applied to the leg. This creates a space between the ball and the socket of your hip so that your surgeon can place instruments into the hip joint.
2. Through a small incision (less than 1cm), your surgeon can insert a long, thin camera (like a very small telescope) into your hip joint.
3. The inside of the joint will be examined, allowing your surgeon to decide whether an operation is required to repair damage or remove tissue or bone interfering with joint movement.
4. Other small incisions (cuts) may be made to insert tools to assess and treat any issues found during surgery.
5. At the end of surgery, the wounds are closed with sutures (stitches), and dressings are applied.

After the procedure

Immediately after surgery, you will be taken to a recovery area and then to your room. Our healthcare team will monitor you and give you medication to relieve any pain. The healthcare team will tell you if you need to have any stitches removed or dressings changed.

Recovery from hip arthroscopy

Recovery after hip arthroscopy varies depending on what procedures are performed during the arthroscopy, and your surgeon is best placed to advise.

If the surgery was performed to diagnose joint pain, recovery is shorter, and most people can return to light activities after 1-2 weeks, with full healing taking 2-4 weeks, depending on whether there were any minor procedures performed.

If it’s to treat structural issues in your hip, you should focus on rest and limited movement for 1 to 2 weeks. Rehabilitation can start almost immediately and last for 6 to 12 weeks and full recovery can take 3 to 6 months, depending on the complexity of the procedure.

Recovery at the hospital

You should be able to go home the same day, but your consultant may ask you to stay overnight.

A physiotherapist will visit you to help you begin to move about on your own. You’ll usually be able to get up as soon as you’ve recovered from the anaesthetic. You may need to use crutches to start with. You’ll be given gentle exercises to help build your muscle strength.

For the first 24 hours after your surgery:

• You will need someone to take you home and stay with you overnight.
• Avoid drinking alcohol.
• Do not sign legal documents, operate machinery or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and coordination.

Managing your recovery at home

There are a few things you can do to aid your recovery. Make sure you follow the healthcare team’s advice carefully and call them if you’re worried about anything.

The advice given below applies to both those who have had a hip arthroscopy for diagnostic purposes as well as for treatment purposes, but the time frame is geared towards those who have had a hip arthroscopy for treatment. The timeframe for those who’ve had a diagnostic hip arthroscopy will be shorter, as full healing is usually around 2 to 4 weeks.

Important things to remember

• Don’t rush your recovery: Progress the intensity and duration of exercise gradually – doing too much too soon can aggravate your healing and potentially set back your healing.
• Listen to your body: Avoid pushing through the pain – while some discomfort is normal, sharp or increasing pain is a signal to slow down and rest.
• Avoid limping: Try to walk with a good walking posture, even if you need crutches to achieve it. Limping can lead to compensatory movements and pain in other joints.

What are the benefits of hip arthroscopy?

A hip arthroscopy aims to find out exactly what the problem is, and for many people, the problem can be treated at the same time. The benefit of keyhole surgery is less pain afterwards and, for some people, a quicker recovery compared to more invasive surgery. The outcomes can be unpredictable and variable, and you will take time to recover. It may take up to 6 months following surgery before a judgment can be made on the success or otherwise of the operation.

How long do the benefits of hip arthroscopy last?

The benefits can last years, but it depends on several factors:

• Underlying condition: Most benefits are usually long-lasting if the procedure addresses the structural issues, such as femoroacetabular impingement or labral tears.
• Severity: For patients with minimal cartilage damage, the benefits tend to last longer, whereas those with more advanced cartilage damage may eventually need further treatment such as a hip replacement.
• Age: Younger patients tend to have longer-lasting results.
• Activity level: Avoiding high-impact activities while maintaining a healthy weight helps preserve joint health.
• Adherence to rehabilitation: This is crucial for lasting results.

What are the risks of hip arthroscopy?

Possible side effects following hip arthroscopy surgery

• Pain – your surgeon may inject a painkiller into your hip to reduce the pain during the initial recovery. The healthcare team will give you medication to control the pain, and you must take it as you are told so you can move about as advised.
• Scarring of your skin, although arthroscopy scars are usually small and neat.
• Numbness of the skin around the scars is common and, usually, temporary, improving in the weeks and months following surgery.

General complications of hip arthroscopy

• Bleeding.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Difficulty passing urine.
• Blood clot in your leg (deep vein thrombosis - DVT).
• Blood clot in your lung (pulmonary embolus - PE).
• Chest infection.

Specific complications of hip arthroscopy

• Continuing pain in your hip.
• Damage to nerves around your hip, leading to weakness numbness or pain in your leg or foot.
• Technical problems, such as one of the surgical instruments breaking inside your hip joint.
• Skin tear in your groin caused by the traction.
• Damage to the joint surface inside your hip.
• Fluid used during the operation leaking into your abdomen or thigh.
• Fracture of the bone near your hip after your surgeon removes a bone spur.
• Hip coming out of the joint (dislocation).
• Developing a lump under your wound.
• Infection in your hip joint.
• Bone forming in muscles around your hip.
• Softening of the bone in your hip.

Alternatives to hip arthroscopy

If you have hip pain, non-surgical alternatives should be the first line of treatment before considering surgery – these include:

• Physiotherapy: to strengthen muscles around the hip.
• Weight loss: To reduce the pressure on the hip joint.
• Pain management: Anti-inflammatory painkillers, topical gels or steroid injections.
• Assistive devices: Canes or orthopaedic footwear/insoles.

Problems inside your hip can also be diagnosed using an X-ray, CT scan or MRI scan, but you may still need a hip arthroscopy or other procedure to treat the problem, such as hip replacement. A hip replacement replaces both the ball and socket of the hip joint and is recommended for those with advanced arthritis or severe joint damage.

How much does a hip arthroscopy cost?

Click here and select your local Nuffield Health hospital to find the guide prices for hip arthroscopy.

Please note that the guide price stated is an approximate cost of treatment only. You will be given a fixed all-inclusive price for treatment following your initial consultation with a consultant.