Under general anaesthesia, the leg is placed in traction to open the hip joint space. Two to three small incisions (portals) are made around the hip. An arthroscope is inserted to visualise the joint. For cam impingement: the bone bump on the femoral head-neck junction is shaved (osteochondroplasty). For pincer impingement: the over-coverage of the acetabular rim is trimmed. For labral tears: the torn labrum is repaired with suture anchors or, if severely damaged, reconstructed with a graft. Damaged cartilage is assessed and treated. The operation takes one and a half to two and a half hours.
Hip arthroscopy is recommended for FAI with confirmed cam and/or pincer morphology on imaging causing groin pain and limitation that has not responded to at least three months of activity modification, physiotherapy, and injection. The best results are in patients with labral tears and minimal or no arthritis.
Physiotherapy (hip-specific rehabilitation programme), activity modification, corticosteroid or PRP injection, and NSAID medication. Many patients with FAI morphology are asymptomatic — surgery treats symptoms, not imaging findings.
X-rays (AP pelvis, Dunn view for cam) and MRI arthrogram showing FAI morphology and labral tear. Diagnostic injection confirming intra-articular pain source. Standard pre-assessment.
Pain relief and improved function in approximately 80–90% of carefully selected patients. Best outcomes in patients under 40 with labral tears and minimal arthritis. Return to sport in most athletic patients.
Traction-related numbnessCommon
Temporary perineal or pudendal numbness from traction. Resolves within hours to days.
Hip stiffnessCommon
Temporary. Physiotherapy essential.
Residual groin painUncommon
Some patients have persistent symptoms.
Lateral femoral cutaneous nerve injuryUncommon
Numbness on the outer thigh from portal placement. Risk approximately 1–5%.
Heterotopic ossificationUncommon
Unwanted bone formation. NSAIDs are given as prophylaxis.
Femoral neck fractureRare
If excessive bone is removed during cam osteochondroplasty.
AVN of femoral headRare
Very rare with proper technique.
Traction injuryRare
Sciatic or pudendal nerve palsy from traction. Usually temporary.
Fluid extravasationUncommon
Fluid tracking causing abdominal distension. Usually self-limiting.
Cartilage damageRare
Inadvertent damage from instruments.
InfectionRare
Hip joint infection. Rare.
General anaesthesia. Supine or lateral position with traction. Traction time is limited to two hours to reduce nerve palsy risk.
Crutches for two to four weeks. Physiotherapy from one week — hip flexor stretching and gluteal activation. Avoid deep flexion and impact for four to six weeks. Return to running at eight to twelve weeks. Return to sport at three to six months. Full recovery six months.
Reviews at two weeks, six weeks, and three months. X-ray at six weeks to confirm adequate bone reshaping.
Will arthroscopy prevent hip replacement?
In patients without significant arthritis, successful hip arthroscopy may delay or prevent the need for hip replacement. However, if there is already established arthritis (Tönnis grade 2 or higher), arthroscopy outcomes are less predictable and hip replacement may still be needed in the future.
How do I know if I have FAI?
FAI is diagnosed by the combination of clinical symptoms (groin pain with certain movements), clinical signs (positive impingement test), and imaging findings (cam or pincer morphology on X-ray/MRI). All three elements should be present — many people have FAI morphology on imaging without symptoms.