Hip Arthroscopy

Indications

  • Symptomatic femoroacetabular impingement (cam, pincer or mixed) after failed nonoperative care
  • Labral tears
  • Loose bodies, chondral flaps and ligamentum teres tears
  • Septic arthritis washout
  • Advanced osteoarthritis is a contraindication
  • Dysplasia (lateral centre edge angle under 20°) is a relative contraindication to isolated osteochondroplasty

Position

  • Supine on a traction table or lateral decubitus
  • Padded, wide perineal post lateralised against the ischium to protect the pudendal nerve
  • Distract in slight abduction, then adduct, with slight internal rotation, aiming for 8 to 10 mm on fluoroscopy
  • Keep traction time under 2 hours

Operative Steps

  1. Break the vacuum seal and distract under fluoroscopy
  2. Establish the anterolateral portal at the anterosuperior trochanter tip with a spinal needle, avoiding the labrum
  3. Place the mid-anterior portal under direct vision
  4. Perform an interportal capsulotomy
  5. Inspect the central compartment, treat pincer lesions and repair the labrum with suture anchors, using the distal anterolateral accessory portal
  6. Release traction, flex the hip and enter the peripheral compartment
  7. Resect the cam lesion and confirm clearance dynamically
  8. Stay anterior to the lateral synovial fold to protect retinacular vessels
  9. Close or plicate the capsule

Postoperative Care

  • Protected weightbearing on crutches after labral repair or osteochondroplasty
  • NSAID prophylaxis against heterotopic ossification
  • Early passive range of motion with limits on extension and external rotation to protect the capsule

Complications

  • Neurapraxia is the most common complication, mainly of the pudendal and lateral femoral cutaneous nerves
  • Pudendal neurapraxia from the perineal post, with perineal numbness
  • Sciatic and femoral nerve traction injury
  • Heterotopic ossification
  • Iatrogenic labral or chondral injury at portal entry
  • Fluid extravasation into the abdomen or retroperitoneum
  • Femoral neck fracture after overresection
  • Avascular necrosis from retinacular vessel injury (MFCA)
  • Persistent impingement from undercorrection

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 12 October 2026.