Hip Arthroscopy

Why this approach — at MOS

Hip arthroscopy is one of the most technically demanding procedures in orthopedic surgery. The joint is deep, the angles are constrained, and the window of safe distraction is narrow. Outcomes depend heavily on surgeon experience, precise portal placement, complete lesion identification, and quality of repair.

Dr. John Christoforetti has dedicated his career to hip arthroscopy and hip preservation surgery. His fellowship training focused specifically on hip arthroscopy, and he has performed this procedure across a broad spectrum of patients — from competitive athletes to recreational adults — managing the full range of intra-articular hip pathology.

The approach at MOS prioritizes joint preservation above all else. Before recommending any surgery, Dr. Christoforetti performs a thorough biomechanical evaluation, reviews high-quality imaging (MRI arthrogram when indicated), and administers a diagnostic/therapeutic injection to confirm the pain generator. When surgery is warranted, the operative plan is individualized: the type and extent of labral work, the degree of osteoplasty, and whether capsular repair is needed are all determined before the first portal is placed.

Labral repair — reattaching the native labrum with suture anchors — is strongly preferred over debridement whenever tissue quality allows. Long-term data show that labral repair and capsular repair together significantly improve 10-year survivorship of the native hip. Capsular closure is performed routinely to restore joint stability.

Who is a candidate?

Indications

• Acetabular labral tear confirmed on MRI arthrogram causing persistent groin or hip pain
• Femoroacetabular impingement (FAI) — cam, pincer, or mixed morphology — with failed non-operative treatment
• Focal articular cartilage damage (chondral lesion) without advanced arthritis
• Loose bodies (fragments of bone or cartilage) within the hip joint
• Iliopsoas tendon impingement or snapping hip syndrome (internal coxa saltans)
• Gluteus medius or minimus tears identified at the greater trochanter
• Synovitis or inflammatory joint disease refractory to conservative care
• Ligamentum teres tears causing hip instability or pain

Contraindications

• Advanced hip osteoarthritis (Tönnis grade 3 or higher) — patients with significant joint space narrowing are generally better served by hip replacement
• Severe hip dysplasia (lateral center-edge angle < 20°) — may require periacetabular osteotomy rather than arthroscopy
• Medical comorbidities that make general anesthesia unsafe
• Severe obesity that significantly increases complication risk
• Active hip joint infection (septic arthritis)
• Absent or near-absent joint space on weight-bearing X-ray

Conservative Treatment First

Surgery is not the first step. Most patients presenting with hip pain receive a structured trial of conservative care before arthroscopy is considered. This typically includes 6–12 weeks of physical therapy targeting hip strengthening, flexibility, and movement mechanics; anti-inflammatory medications (NSAIDs); and one or two image-guided cortisone injections to reduce inflammation and confirm the intra-articular source of pain. Activity modification — reducing or temporarily stopping high-impact activities — is also a standard component of non-operative management.

When imaging confirms a structural problem (labral tear, FAI, cartilage lesion) and conservative measures have failed to provide lasting relief, surgery becomes a reasonable next step. Patients who continue to have significant functional limitations despite 3–6 months of appropriate non-operative care are the clearest candidates.

The procedure

What Is Hip Arthroscopy?

Hip arthroscopy is a minimally invasive surgical procedure in which a surgeon inserts a small camera (arthroscope) and instruments through two or three small incisions around the hip joint to diagnose and treat problems such as labral tears, femoroacetabular impingement, cartilage damage, and loose bodies — without the recovery burden of open hip surgery.

The hip is a ball-and-socket joint: the rounded top of the femur (thighbone) fits into the acetabulum (a cup-shaped socket in the pelvis). A ring of tough fibrocartilage called the labrum deepens the socket, seals joint fluid inside, and stabilizes the joint. When the labrum tears, the bone develops an abnormal shape, or cartilage is damaged, the hip loses its normal mechanics and pain follows — often a deep groin ache that worsens with sitting, pivoting, or athletic activity.

Hip arthroscopy allows a surgeon to directly visualize the entire joint interior and address problems with precision. The surgeon works through portals roughly the diameter of a pencil, using specialized curved instruments designed for the tight confines of the hip. Because so little soft tissue is disrupted, patients go home the same day and begin physical therapy within days of surgery.

At Maryland Orthopedic Specialists, hip arthroscopy is the foundation of the hip preservation program. The goal is to restore normal joint mechanics, relieve pain, and — whenever possible — delay or eliminate the need for hip replacement.

What Happens During Hip Arthroscopy?

Arrival and Anesthesia Hip arthroscopy at our ambulatory surgery center is performed under general anesthesia combined with a nerve block (typically a femoral or lumbar plexus block). The nerve block reduces post-operative pain and limits narcotic use. After anesthesia, the patient is positioned on a specialized traction table — either in the lateral decubitus (side-lying) or supine (face-up) position depending on surgeon preference and the pathology being addressed.

Traction and Portal Placement The hip joint does not open easily because the femoral head is deeply held within the acetabulum. Controlled traction is applied to the leg to distract (open) the joint by approximately 8–10 millimeters — just enough to allow the arthroscope and instruments to enter safely. The surgeon uses fluoroscopy (real-time X-ray) to confirm positioning and place guide needles precisely before creating the portals.

Two or three small portals are made in the skin around the hip — most commonly an anterolateral portal and an anterior or mid-anterior portal, each roughly 5 mm in length. The arthroscope is inserted through one portal; instruments pass through the others.

Intra-articular Work (Central Compartment) With the joint distracted, the surgeon inspects the acetabular labrum, articular cartilage, ligamentum teres, and synovium. Labral tears are repaired using suture anchors — small implants that anchor suture into bone, allowing the labrum to be reattached and restored to its normal position against the acetabular rim. Chondral lesions may be debrided and stabilized. Loose bodies are removed. This phase typically takes 30–60 minutes.

Peripheral Compartment Work After intra-articular work is completed, traction is released and the surgeon examines the peripheral compartment — the space around the femoral neck. This is where cam-type FAI deformity (excess bone on the femoral head-neck junction) is addressed. Using a high-speed shaver and burr, the surgeon precisely reshapes the femoral head to eliminate the cam lesion. Pincer lesions (rim overcoverage) are addressed from the acetabular side. The capsule may be repaired after instruments are removed.

Closure and Recovery Room The small portals are closed with a single suture or skin tape. The patient is taken to recovery, where the nerve block provides several hours of comfortable pain control. Most patients are discharged home within 2–3 hours. Crutches are used for the first 2–4 weeks to protect the repair.

Recovery timeline

Frequently Asked Questions