Key-hole hip surgery (hip arthroscopy)

Femoro-Acetabular Impingement (FAI) Syndrome treated by key-hole hip surgery (hip arthroscopy)


Key-hole hip surgery is used to assess and treat conditions such as a labral tear.

Hip and groin pain can be difficult to diagnose. Femoroacetabular impingement was first described almost 100 years ago, however it has only been in the past 20 years that treatment options have been developed. In 2016, experts in the field of treating patients with FAI coined the term FAI syndrome.

‘FAI syndrome is a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs and imaging findings. It represents symptomatic premature contact between the proximal femur and the acetabulum.’ Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement British Journal of Sports Medicine 2016;50:1169-1176. 

Essentially, what this is saying is that a combination of the shape and design of an individuals hip joint in combination with the movements of certain activities, can lead to FAI. Once this becomes painful, then the criteria for FAI syndrome has been met.

Due to the complexity, and the fact that this is a relatively new and developing area of hip surgery, it is important to make sure that a clinical assessment is done alongside appropriate imaging to ensure that an accurate diagnosis is made.

Why would I need key-hole hip surgery?

Hip and/or groin pain:

without significant of osteoarthritis.


that continues despite specialist rehabilitation or physiotherapy.

that interferes with normal day to day activities including sexual intercourse.


that stops you from be able to participating in physical activity (sports, dancing, yoga, martial arts, etc.)

What happens during the procedure?

1. You will be fully assessed to check you are physically well enough for surgery.

This starts with the consultation with your surgeon in clinic, you will then attend a pre-assessment clinic where you are assessed by a specialist nurse and sometimes an anaesthetist if you have other medical problems. You may require some additional blood tests and investigations before your surgery. You will have a chance to ask questions about your anaesthetic and what happens before and after surgery.

What happens during the procedure?

2. A spinal or general anaesthetic are used so you do not feel the surgery.

For the majority of patients a general anaesthetic is used for the surgery. You will have a chance to discuss the anaesthetic before the surgery.

What happens during the procedure?

3. The leg is inserted in a special table to pull on it to create space in the joint for the keyhole camera.

The surgeon and their team will meticulously prepare the hip prior to surgery and apply sterile drapes over the hip. A careful incision is made in the skin and the keyhole camera is inserted into the hip joint. The hip can then be carefully examined through the camera.

What happens during the procedure?

4. Depending on the cause of the pain procedures can take place through the small incisions.

Once the camera is in the hip the joint, the structures around the joint are viewed for potential causes of the pain. The labrum (tissue to make the hip joint more stable) can be repaired or trimmed to stop the hip joint catching it when it moves. Abnormal bony lumps can also be removed with a special toll which shaves the bone.

What happens during the procedure?

5. You return to the ward and are helped on to your feet by the physios and discharged the same day as surgery.

You will spend sometime in recovery after the operation. As soon as you are well enough you will be transferred to the ward. On the ward you will be seen by physios and nurses and as soon as possible you are encouraged to walk. You may have a check xray on the day of the surgery and will return home the same day when it is safe for you to do so.


Below is a list of potential complications that has been published in the scientific literature. It is important to discuss these with your operating surgeon.

During the operation:

  • Injury to the Acetabular Labrum and Articular Cartilage (Undefined)
  • Injury to the Neurovascular Structures (Rare)
  • Injuries Secondary to Traction (1-2%)
  • Inadequate Osseous Reshaping (Most common cause for revision hip arthroscopy)
  • Chondral Damage due to Misplaced Anchors (Undefined)
  • Fluid Extravasation (Undefined)
  • Hypothermia (Undefined)

Early Post-operative Complication:

  • Infection (Less than 1%)
  • Deep Vein Thrombosis (DVT) (Less than 1%)
  • Instability (Undefined)

Late Post-operative Complications:

  • Avascular Necrosis of the Femoral Head (Less than 0.001%)
  • Adhesions (Undefined)
  • Heterotopic Ossification (1%)
  • Femoral Neck Fracture (Rare)
  • Trochanteric Bursitis and Iliopsoas Tendinitis (Undefined)

Naoki Nakano and Vikas Khanduja. Complications in Hip Arthroscopy. Muscles Ligaments Tendons J. 2016 Jul-Sep; 6(3): 402–409. PMID: 28066747

Recovery time

Your surgeon and physiotherapist will tailor your rehabilitation according to your specific diagnosis and treatment. Below is a basic guide on what to expect in the weeks immediately following your surgery.

Week 0–2
Crutches until walking without a limp. No impact. Stationary bicycle as soon as comfortable.

Week 2–4

Return to desk based jobs. Return to driving.

Week 4-6

Phased return to work.

Week 6+

Phased return to impact activities such as running.

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