The inner surfaces of the hip joint (and more recently some structures nearby such as muscles and tendons around the hip) can be examined using keyhole techniques, which have been developed over the past 20 years.

This keyhole surgical technique has been refined over the past decade, in a similar method to how patients have had knees and shoulders (as well as abdominal conditions) treated since the early 1980’s. The technique is not suitable for all patients and can be technically challenging, as the hip joint is considered a deep joint, being well covered in all directions by large, strong muscles, as well as its spherical shape being difficult to negotiate compared to a more flat joint surface such as seen in the knee.

In order to perform a hip arthroscopy the patient usually needs a general anaesthetic to allow the muscles to relax. Once this is done a special operating table is used to apply enough force to pull the femoral head away from the acetabulum by approximately 1cm. This creates a space in which a 4mm diameter telescope (an arthroscope) can be introduced into the hip joint, using two to four small (1-2cm) incisions around the front and sides of the upper part of the femur. Using the telescope, the labrum and the articular cartilage of the femoral head and acetabulum can be inspected as well as any bumps on the femoral head or prolongations of the acetabular walls. In some cases cartilage damage can be treated if fairly localised, chondrolabral separations may be repaired and femoral head bumps or prolongations of the acetabular wall can be removed using a miniature motorised burr. If the cartilage damage is extensive or very advanced, this is considered hip arthritis and up to (and including) now has not been able to be well treated with arthroscopic surgery alone. Initially, arthroscopic treatment of extensive labral injury by removing the damaged tissue has not been done well to date, frequently resulting in a more rapid progression to arthritis. More recently, some techniques to attempt to replace a damaged labrum are being pioneered by select surgeons, but it is yet to be seen as to whether this is an effective treatment in the medium to long term.

New techniques have also been developed for treating conditions near the hip joint but external to it, such as inflammation of the surrounding tendons, fascia and bursa, and even the sciatic nerve. There are also sources of hip impingement that can occur outside of the true hip joint such as ischio-femoral impingement and subspinous impingement which are starting to be treated arthroscopically, but in fairly small numbers of cases and by even smaller numbers of surgeons.

Although performed through small incisions, the amount of work carried out via the arthroscope on the hip joint can often be fairly extensive, and may be associated with a number of risks, including nerve injuries due to the force and pressure required to open the hip joint sufficiently to enable entry of the arthroscope, fractures of the femoral neck due to the amount and location of the bone removed during treatment of a cam lesion, and very rarely hip joint dislocation due to destabilisation of ligaments in the hip joint capsule, as well as the general risks of surgery on the lower limb.