Keyhole Hip Surgery (Hip Arthroscopy)

What is Keyhole Hip Surgery (Hip Arthroscopy)?

Keyhole hip surgery, also known as hip arthroscopy, is a minimally invasive surgical procedure used to diagnose and treat a range of hip joint problems. Instead of making a large incision, Dr Williams uses two to four small incisions (typically 1-1.5cm each). Through these openings, a tiny camera called an arthroscope and specialised instruments are inserted into the hip joint.


The camera projects detailed images onto a screen, allowing Dr Williams to see the inside of the hip joint in real time. This approach enables precise treatment of cartilage damage, labrum (the rim of cartilage around the hip socket), l or bone, while minimising disruption to surrounding muscles and tissues.

Keyhole Hip Surgery (Hip Arthroscopy)

Who is Suitable for Keyhole Hip Surgery?

People who may be suitable include:

  • Young patients with persistent hip pain due to certain conditions: Pain lasting several months that has not improved with physiotherapy, medication, or activity modification
  • Femoroacetabular impingement (FAI): This is the most common and well-researched indication for hip arthroscopy.  In this condition, an abnormal shape to the top of the femur, called a ‘cam deformity’ or over-growth of the rim of the socket called a ‘pincer’, can lead to mechanical conflict called impingement.  Patients often experience a painful ‘pinching’ or catching sensation with certain movements.
  • Labral tears: Damage to the specialised cartilage rim of the hip socket
  • Cartilage injuries: Localised cartilage damage without advanced arthritis
  • Loose bodies: Small fragments of bone or cartilage floating inside the joint
  • Hip flexor tendinitis post hip replacement: Psoas irritation following hip replacement occasionally benefits from arthroscopic tendon release.
  • Athletes and active individuals: Particularly those with mechanical symptoms such as catching, clicking, or locking


People who may not be suitable include:

  • Advanced hip osteoarthritis: Patients with established arthritis seen on MRI or X-ray are generally not candidates for keyhole hip surgery, as there is little that can be done to treat cartilage damage arthroscopically.
  • Severe hip stiffness or deformity: Where access with arthroscopy is limited
  • Poor general health: Making surgery or rehabilitation unsafe
  • Older patients: Dr Williams performs hip arthroscopy only in very select cases over the age of 50, as outcomes are less predictable and total hip replacement may be a better alternative for structural issues involving the hip joint.


A thorough clinical examination, X-rays, and MRI scans are essential to determine suitability.


Benefits of Keyhole Hip Surgery

Keyhole hip surgery offers several advantages compared to traditional open surgery.


Benefits may include:

  • Smaller incisions: Reduced scarring and better cosmetic results
  • Less muscle damage: Muscles are moved aside rather than cut
  • Reduced pain after surgery: Compared to open procedures
  • Shorter hospital stay: Often a day surgery or an overnight stay
  • Faster recovery: Earlier return to work and daily activities
  • Improved hip function: Reduced pain, better movement, and improved stability
  • Joint preservation: Can delay or prevent the need for hip replacement in suitable patients


It is important to note that outcomes depend heavily on correct diagnosis, appropriate patient selection, and adherence to rehabilitation.


Types of Keyhole Hip Surgery

Hip arthroscopy is just a way of accessing the hip joint.  The actual surgery may involve various procedures depending on the underlying pathology.

Common types include:

  • Labral repair: Stitching and reattaching a torn labrum to the hip socket
  • Labral debridement: Trimming damaged labral tissue when repair is not possible
  • FAI surgery: Shaving excess bone from the femoral head (cam lesion) or socket (pincer lesion) to reduce impingement
  • Tendon release: Painful psoas irritation after hip replacement may be effectively treated by the release of the tendon.
  • Capsular plication: The joint capsule is routinely repaired at the end of the procedure and can be tightened in patients with minor instability.
  • Cartilage repair: Treating focal cartilage defects using smoothing or microfracture techniques
  • Loose body removal: Extracting free fragments within the joint
  • Synovectomy: Removing the inflamed joint lining
  • Ligamentum teres treatment: Debridement of the ligament inside the hip


Often, more than one procedure is performed during the same operation.


Alternative Options to Keyhole Hip Surgery

Keyhole hip surgery is usually considered only after non-surgical treatments have been tried.


Alternative options may include:

  • Activity modification: Avoiding movements that worsen symptoms
  • Physiotherapy: Strengthening hip and core muscles, improving movement patterns
  • Pain relief medication: Anti-inflammatory medications, where appropriate
  • Injections: Cortisone or platelet-rich plasma (PRP) injections in selected cases
  • Open hip surgery: Sometimes required for patients with complex conditions, including hip dysplasia or excessive femoral anteversion/retroversion, in whom a corrective osteotomy may be a more appropriate procedure.
  • Hip replacement surgery: More appropriate for advanced arthritis


Dr Williams will discuss whether continued non-surgical management or an alternative surgical approach is more suitable.


Preparation Before a Keyhole Hip Surgery

Preparation is important for a smooth surgery and recovery.


Before surgery, patients are usually advised to:

  • Have imaging completed: Dr Williams will often require specific X-rays, CT scans and MRI scans for planning
  • Adjust medications: Some medications may need to be stopped temporarily
  • Plan support at home: Assistance with transport home and daily tasks after surgery
  • Plan time off work: Most patients will need at least 2 weeks of work and longer if work involves manual labour or excessive walking/standing
  • Plan postoperative physiotherapy: you should book in with your regular physiotherapist at 2 weeks post-op to commence your rehab protocol.


Dr Williams and his team will provide further detailed instructions.


Keyhole Hip Surgery Procedure

Keyhole hip surgery is performed under general anaesthesia.


During the procedure:

  • Positioning: You are positioned on a special hip arthroscopy table to allow safe access to the hip. Dr Williams uses a supine postless technique, meaning you will be lying comfortably on your back throughout the procedure, with your skin on a soft memory foam mat. Your feet are secured in special boots that allow gentle distraction of the hip joint. The mat provides enough friction that there is adequate counter-traction, and a perineal post in the groin is no longer required.
  • Joint access: Under x-ray guidance, a joint access needle is used to inject a small amount of air into the joint to break the vacuum seal and gentle traction is applied to create space inside the joint.
  • Camera insertion: The first portal is created, and the arthroscope is inserted, allowing Dr Williams to obtain a clear view of the hip structures to confirm the preoperative diagnosis. Dr Williams will take pictures and video to document the pathology.
  • Portal creation: 2-4 portals are created from the skin into the joint under direct camera vision, allowing various instruments to pass into the joint at the correct angles.
  • Treatment: Once appropriate joint access has been attained, Dr Williams carries out the necessary parts of your individual hip arthroscopy procedure, such as labral repair, bony reshaping (pincer resection, aka acetabuloplasty; cam resection, aka femoral osteochondroplasty) and capsular closure. 
  • Closure: Skin incisions are closed with dissolvable sutures under the skin, surgical glue and waterproof dressings


The procedure typically takes 2-2.5 hours, depending on complexity.


What to Expect After a Keyhole Hip Surgery?

Although the skin incisions are small, the procedure performed inside the hip can be significant. Recovery after hip arthroscopy is gradual and requires commitment to rehabilitation.


After surgery, patients can expect:

  • Hospital stay: Most patients stay overnight for comfort.
  • Pain and swelling: Usually manageable with medication and regular ice packs or cryotherapy.
  • Crutches: Often required for 2–4 weeks, depending on the procedure and individual patient. Dr Williams encourages most patients to fully weight-bear, with crutches to provide extra support.
  • Physiotherapy: You will be seen by a physiotherapist in the hospital and shown some gentle post-op exercises. Formal physio usually starts after 2 weeks and continues for several months.
  • Return to work: Desk work in 1–2 weeks; physical work will take longer.
  • Return to sport: Commonly 3–6 months, sometimes longer.


Following rehabilitation instructions closely is important for the best outcome.


Keyhole Hip Surgery Prognosis

The prognosis for keyhole hip surgery is generally good in appropriately selected patients.


Expected outcomes include:

  • Significant pain reduction: Particularly mechanical pain
  • Improved hip movement and function
  • High satisfaction rates: Especially in younger, active patients
  • Delayed arthritis progression: In some cases


However, outcomes are less predictable in patients with established arthritis, poor cartilage quality, hip dysplasia, ligamentous laxity or older age.


Keyhole Hip Surgery Risks

Although minimally invasive, keyhole hip surgery still carries risks.


Potential risks include:

  • Infection: Rare but serious
  • Bleeding or bruising
  • Nerve irritation or numbness: Usually temporary
  • Blood clots: Uncommon but possible
  • Persistent pain or stiffness
  • Need for further surgery: Including eventual hip replacement


Dr Williams will explain these risks in detail before surgery.


What if Keyhole Hip Surgery is Delayed?

Delaying surgery may have different consequences depending on the natural history of the underlying condition. In general, hip arthroscopy is not usually an urgent surgery, and the timing can be safely scheduled around a patient’s work, schooling, sporting and family commitments.


Possible effects of delay include:

  • Worsening pain and function
  • Progressive cartilage damage
  • Reduced effectiveness of surgery later
  • Increased risk of developing arthritis


In many cases, delaying surgery while maximising conservative treatment is highly appropriate. In others, early intervention may better protect the hip joint. Dr Williams will discuss the timing of surgery in your individual case during your consultation.