What Is Hip Arthroscopy? (video/podcast)

Soccer, pickleball, running, surfing and other sports are a great way to exercise and can provide both physical and mental health benefits. However, if hip pain interferes with your favorite activities (especially if you are under age 60), you may be wondering if you need hip surgery.

While hip replacement is an excellent treatment for some patients, minimally invasive hip arthroscopy may be an option to relieve pain and restore mobility. In this video, San Diego Health host Susan Taylor discusses arthroscopic hip surgery with Mark Cinque, MD, an orthopedic surgeon at Scripps Clinic Torrey Pines and Scripps Clinic Carmel Valley.

Your hip is a ball-and-socket joint that connects your leg to the trunk of your body and allows your leg to move in different directions. If the joint is damaged by arthritis, wear and tear, injury or another factor, normal hip movements may be difficult and even painful.

As the name implies, hip replacement surgery is a procedure that replaces the damaged hip joint with a new, artificial plastic or metal joint. Typically, hip replacement is recommended for patients over 60 whose hip joint is severely damaged by arthritis, but it may not be right for younger patients.

“In our younger patients, we don’t jump to hip replacement because they have a lot of years of use and mileage left, so to speak, on their hips. As a result, we turn more of our focus towards hip preservation without having to replace the actual parts of their hip with metal and plastic,” says Dr. Cinque. “These parts can last 20 to 30 years, but in a young patient that may not be long enough to give them a long-lasting, durable and functional result.”

Hip arthroscopy preserves the hip joint and the labrum, which is the soft tissue structure around the outside of the hip socket that helps absorb shock during movement. It is a minimally invasive procedure that involves making three to four small incisions in and around the hip joint to access and repair injuries to the bony structures and labrum.

Arthroscopy is usually recommended for younger, active patients who do not have arthritis, but have hip impingement that interferes with sports, exercise or other activities.

“Hip impingement is a catch-all term to describe either bony structures or soft tissues that get pinched when you’re moving your hip or doing the activities you love,” explains Dr. Cinque, who specializes in sports-related injuries.

“A lot of times it’s during sports that have repetitive motion, especially those with what we call hip flexion, where you’re bringing the knee up and down repetitively. Also, young athletes who do one single sport at high volumes have a higher rate of hip impingement symptoms,” he adds.

A hip impingement diagnosis begins with a thorough physical examination, which may be followed by X-rays as well as an MRI to look at the soft tissue structures.

“If you think about it like a house, we look at the foundation of the house, the bones of the hip, using X-rays. Then we look at the plumbing and the electricity of the house on the MRI,” says Dr. Cinque. “And then based on your exam and those imaging findings, we make a decision whether or not hip arthroscopy is appropriate.”

Typically, candidates for arthroscopic hip surgery have exhausted non-surgical care options, such as medications or physical therapy, and are still having persistent groin or hip pain.

Minimally invasive arthroscopy of the hip is usually an outpatient procedure. Patients arrive in the morning, are in surgery for a few hours and spend some time in the recovery room before going home. Recovery time varies depending on the patient and the condition of the hip before surgery.

“For the most part, we limit a patient’s ability to put their full weight on their leg for about two weeks until the muscles around the hip kind of bounce back from surgery,” says Dr. Cinque. “But we do like to get you moving with physical therapy as soon as we can, which can mean starting the day after surgery, and then continuing that process for probably close to six months.”

Your surgeon will work with your physical therapist to monitor your progress and determine when you can safely return to sports and other activities. Typically, this is around six months, although it can take up to a year to see the full benefit of surgery.

“Hip arthroscopy has really revolutionized how we think about hip preservation and how we get our athletes back to sport,” says Dr. Cinque. “It’s a powerful tool for us to be able to address these issues.”