Overview
Hip arthroscopy treats the two problems that most often cause groin pain in active adults under 50: a torn labrum, the cartilage rim that seals the socket, and femoroacetabular impingement (FAI), the extra bone on the ball or socket rim that tears it. Through two or three small incisions, Dr. O'Donnell stitches the labrum back to the socket and reshapes the bone so the ball rotates without pinching. The goal is a hip that flexes and rotates without catching, and a labrum that keeps sealing and cushioning the joint for decades.
Most patients find that the catching and the deep groin ache with sitting and pivoting resolve, and they return to running, cycling, sailing and field sports. The operation is done as an outpatient at Bayside Surgery Center.
Who It's For
The best candidates have a labral tear on MRI, a cam or pincer deformity on X-ray, a positive impingement test on exam, and symptoms that have not settled after 6 to 12 weeks of physical therapy. A diagnostic injection that gives clear, if temporary, relief confirms the pain is coming from inside the joint. Read more about femoroacetabular impingement and hip labral tears.
Arthroscopy does not help an arthritic hip. When X-rays show the joint-space narrowing of established hip arthritis, repairing the labrum does not relieve the pain and the hip tends to deteriorate faster afterward; those patients are better served by non-operative care or, when the time comes, total hip replacement. Pain on the outside of the hip that is worse lying on that side is usually trochanteric bursitis, treated without surgery.
A labral tear or a cam shape on imaging is not by itself an indication for arthroscopy; both are common in hips that do not hurt. Dr. O'Donnell recommends the operation only when the impingement test reproduces the pain, the imaging shows a correctable shape with preserved joint space, an injection has confirmed the joint as the source, and therapy has failed. See hip impingement and labral tears.
What the Procedure Involves
The operation is done under general anesthesia with a regional block for pain control afterward. The leg is placed in gentle traction on a specialized table to open the joint by about a centimeter, enough to pass a camera and instruments between the ball and socket without scraping the cartilage.
With the joint open, Dr. O'Donnell examines the labrum and cartilage directly. Extra bone on the socket rim (a pincer deformity) is trimmed, and the labrum is reattached to the freshened rim with two to four small suture anchors so that it seals the joint again. Traction is then released and the ball is examined as the hip is flexed and rotated. The cam bump on the neck of the femur is shaved down with a burr under X-ray guidance until the hip moves without contact, and the capsule opening is closed with sutures. Exposed bone on the socket is treated with microfracture at the same time. The procedure takes about 90 minutes to two hours.
Risks & How They Are Minimized
The complication specific to hip arthroscopy is temporary numbness in the groin, thigh or foot from the traction post and the pull on the leg. It almost always resolves within days to weeks. Dr. O'Donnell uses a well-padded post and limits traction to the socket-side work. Infection is uncommon after arthroscopy and is guarded against with a dose of antibiotic before the incision. Blood clots are rare in this age group but are addressed with early walking, ankle pumps and aspirin for 14 days in patients with risk factors.
Stiffness from scar tissue in the capsule is prevented by passive motion and the stationary bike from day one. The most common reason for persistent pain afterward is bone that was under-resected or arthritis that was already present, which is why the correction is confirmed with X-ray during surgery and patients with joint-space loss are advised against the operation.
Recovery & Rehabilitation
Rehabilitation protects the repaired labrum and closed capsule while restoring motion early enough to prevent adhesions. Weight bearing is limited to a flat-foot, partial load of about 20 lb on crutches for the first 2 to 3 weeks, and end-range positions that pull on the repair are avoided early. Dr. O'Donnell's protocol runs in four phases.
| Phase | Timing | What happens |
|---|---|---|
| Protection & motion | Weeks 0–3 | Partial weight bearing on crutches. Passive motion and gentle circumduction, stationary bike with no resistance, glute, quad and core isometrics, heel slides. No active hip flexion and no extension past neutral with external rotation. |
| Progressive motion & load | Weeks 3–6 | Weight bearing advanced to full and crutches weaned. Full range of motion while avoiding pinching positions. Mini-squats, bridges, core and gluteal strengthening, balance work. Advance when motion is full and pain-free and gait is normal without crutches. |
| Strengthening | Weeks 6–12 | Progressive resistive hip and core strengthening, single-leg work and balance, elliptical conditioning. Light jogging late in the phase if criteria are met. Advance at 80% strength of the opposite side. |
| Return to sport | Months 3–6 | Running progression, then agility, cutting and plyometrics, then sport-specific drills. Cleared on symmetric strength and passing functional and hop testing, typically at 4 to 6 months. |
Desk work is possible within the first week on crutches, though prolonged sitting is uncomfortable early. Driving resumes once off crutches and narcotic pain medication, usually 3 to 4 weeks for a right hip and sooner for a left. Running begins around 3 months if strength criteria are met, and return to cutting and pivoting sport is typically 4 to 6 months.
Protocol summary
Precautions: flat-foot partial weight bearing of about 20 lb with crutches for roughly 2 to 3 weeks, longer after microfracture; no active hip flexion past 90° and no end-range external rotation or extension early; no pivoting or aggressive stretching for 6 weeks. A hip brace or continuous passive motion machine may be used at the surgeon's discretion.
Criteria: crutches are weaned when pain is controlled and gait is normalizing; strengthening begins once motion is full and pain-free; running begins at 80% strength compared with the opposite side; return to sport requires symmetric strength and passing hop testing, typically at 4 to 6 months. Progression may be slowed based on what was repaired at surgery.
Physical Therapy Protocol
Hip Arthroscopy PDF ↗Frequently Asked Questions
How long are you on crutches after hip arthroscopy?
About 2 to 3 weeks with partial, flat-foot weight bearing of roughly 20 lb, then a gradual progression to full weight bearing over weeks 3 to 6. If a microfracture was done for exposed bone on the socket, crutches are used longer to protect the healing surface. They come off for good once you can walk without a limp.
Is hip arthroscopy worth it for a labral tear?
When the tear comes from impingement in a hip with healthy joint space, repairing the labrum and reshaping the bone relieves the catching and groin pain in most patients and protects the joint. When the tear sits in an arthritic hip, arthroscopy does not help and can make things worse, so Dr. O'Donnell recommends it only after X-rays and MRI show the joint is a good candidate.
How long until I can drive after hip arthroscopy?
Once you are off crutches, off narcotic pain medication and can move your foot between the pedals without hesitation. For a right hip that is usually 3 to 4 weeks; for a left hip with an automatic transmission it can be sooner.
When can I run after hip arthroscopy?
A jogging progression usually begins around 3 months, once hip strength reaches 80% of the opposite side and functional movement is pain-free. Cutting and sport-specific training follow over months 3 to 6, with clearance based on symmetric strength and hop testing rather than a date.
Does the extra bone grow back after FAI surgery?
No. The cam bump on the femoral neck and the overhanging socket rim form during adolescence and do not regrow once reshaped in adults. The more common reason for persistent impingement after surgery is bone that was not resected enough the first time, which is why Dr. O'Donnell confirms the correction with X-ray during the operation.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.