Hip arthroscopy: keyhole surgery for impingement and labral tears

In femoroacetabular impingement the shape of the ball or the socket causes the bones to catch against each other at the edge of the hip, sometimes tearing the rim of cartilage (the labrum). The result is groin pain, clicking and pain on bending or twisting.

The EOC page says people usually qualify if they have hip or groin pain without significant osteoarthritis that persists despite physiotherapy or limits daily activity and sport. Where arthritis is already established, keyhole surgery is less likely to help and other options, including hip replacement, are discussed.

Physiotherapy is therefore usually tried first, and the scan findings are interpreted alongside your symptoms rather than on their own.

You will have a pre-assessment with nursing staff and, if you have other medical conditions, an anaesthetist. Follow fasting instructions and bring comfortable loose clothing and your crutches if you already have them. Learn how to use elbow crutches before the operation, because you will rely on them.

Think about your first fortnight: a bed on one level if possible, a plan for showering safely, and help with shopping and lifting.

NHSGGC describes a general anaesthetic and an operation of one to two hours. EOC notes spinal anaesthetic is also available. The leg is positioned on a special table so the ball can be gently drawn out of the socket and a camera and instruments passed in through small cuts.

The surgeon can repair or trim the labrum, reshape the bony bump that causes impingement and smooth or treat damaged cartilage. After recovery, physiotherapists help you stand and walk with crutches and you go home the same day or the next.

The EOC page states infection and deep vein thrombosis each occur in less than 1% of cases, with rare nerve or blood vessel injury, and notes heterotopic ossification (extra bone forming around the hip) in around 1%. Other possible issues include stiffness, numbness around the groin from traction and persisting pain.

No operation can guarantee that pain will go. The surgeon should explain how arthritis changes, if present, affect your chance of benefit.

EOC lists crutches and no impact for weeks zero to two, a return to desk work and driving at weeks two to four, and gradual return to running from about six weeks. NHSGGC takes a more cautious line where microfracture is done, requiring minimal weight through the hip for four to six weeks, and says return to sport depends on the procedure and is decided by your physiotherapist.

Rehabilitation lasts at least three months. Driving is allowed once you can walk without crutches, change gear and brake in an emergency comfortably.

• Redness, swelling, heat or discharge from a wound: see your GP promptly.

• Calf pain or heat: possible clot.

• Sudden breathlessness: call 999.

• Severe, rising pain or loss of feeling in the leg.

• Does my scan show arthritis, and how does that affect my chance of benefit?

• Will my labrum be repaired or trimmed?

• Will microfracture be needed, and does that change weight-bearing?

• How long will I need crutches, and who supervises rehabilitation?

Hip arthroscopy is a specialist operation. In the NHS, access may be through a musculoskeletal pathway that expects physiotherapy first; privately you may get an earlier appointment. In both, ask about the surgeon's experience with hip arthroscopy specifically and about the physiotherapy you will have afterwards.